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Biomedical subjects

Stephen Rollnick

Publications and source records attributed to Stephen Rollnick.

15 recordsLinked to original sources
PubMed2005

Measuring adaptations of motivational interviewing: the development and validation of the behavior change counseling index (BECCI).

One of the most common challenges faced by health professionals is encouraging patients to change their behavior to improve their health. This paper reports the development of a checklist, the behavior change counseling index (BECCI). This aims to measure practitioner competence in behavior change counseling (BCC), an adaptation of motivational interviewing suitable for brief consultations in healthcare settings. The checklist has demonstrated acceptable levels of validity, reliability and responsiveness, and aims to assist trainers and researchers in assessing change in practitioner behavior before, during and after training in BCC. BECCI will also provide valuable information about the standard of BCC that practitioners were trained to deliver in studies of BCC as an intervention.

Clinical Competence↗
PubMed2005

When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour.

AIMS: In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. DESIGN: Experimental manipulation of levels of patient resistance in a role play. SETTING: The study was conducted at the start of a 2-day health behaviour change workshop. PARTICIPANTS: Thirty-two practitioners who had registered for the workshop. INTERVENTION: The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. MEASUREMENTS: Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. FINDINGS: Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. CONCLUSIONS: Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes.

Adult↗
PubMed2005

Communication, stress and distress: evolution of an individual support programme for medical students and doctors.

BACKGROUND: The stress and distress that can be associated with poor communication is well recognised. The problem of how to manage this effectively has yet to be solved. METHODS: In December 2001, the Communication Skills Unit sited in the Department of General Practice in the University of Wales, College of Medicine set up a pilot project for medical students and qualified doctors who were perceived to have communication difficulties. Referrals were made via the deaneries following an agreed format. Initial assessments were used to build an individually tailored programme addressing clients' needs. DISCUSSION: Throughout the year a variety of problems were encountered ranging from language difficulties to bullying and mental health issues. Anecdotal evidence of improvements has been clear, but measuring the outcome of this intervention has proved to be more challenging. Our efforts are now focused on refining assessment and evaluation. This type of service can provide the link between national and local initiatives as well as helping to develop strategies for assessment and training in communication.

Anxiety↗
PubMed2004

Communicating about expected course and re-consultation for respiratory tract infections in children: an exploratory study.

Acute respiratory tract infection is the commonest reason for children consulting, and about one-fifth re-consult for the same illness episode. Fifty-nine audiotape recordings from nine general practitioners (GPs) consulting with children with acute respiratory tract infections were examined. Prognosis was mentioned in only 22 consultations, with GPs predicting a brief course in 11, a possibly longer than expected course in six, and with predicted duration not made explicit in five. Carers were invited to re-consult if they were 'unhappy' with the child's condition in 11 consultations, and specific triggers to re-consult were provided in 15. A patient information leaflet was given out only once. Providing carers with an evidence-based account of the likely clinical course and communicating specific triggers to re-consult may help them manage more of these illness episodes without re-consulting.

Acute Disease↗
PubMed2003

Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of programmes of screening in general practice for excessive alcohol use and providing brief interventions. DESIGN: Systematic review and meta-analysis of randomised controlled trials that used screening as a precursor to brief intervention. SETTING: General practice. MAIN OUTCOME MEASURES: Number needed to treat, proportion of patients positive on screening, proportion given brief interventions, and effect of screening. RESULTS: The eight studies included for meta-analysis all used health questionnaires for screening, and the brief interventions included feedback, information, and advice. The studies contained several sources of bias that might lead to overestimates of the effects of intervention. External validity was compromised because typically three out of four people identified by screening as excessive users of alcohol did not qualify for the intervention after a secondary assessment. Overall, in 1000 screened patients, 90 screened positive and required further assessment, after which 25 qualified for brief intervention; after one year 2.6 (95% confidence interval 1.7 to 3.4) reported they drank less than the maximum recommended level. CONCLUSIONS: Although even brief advice can reduce excessive drinking, screening in general practice does not seem to be an effective precursor to brief interventions targeting excessive alcohol use. This meta-analysis raises questions about the feasibility of screening in general practice for excessive use of alcohol.

Alcoholism↗
PubMed2002

A motivational interviewing perspective on resistance in psychotherapy.

This article applies the motivational interviewing approach to resistance, which is conceptualized as the product of an interaction between the therapist and client rather than a static client characteristic. The underlying principles of motivational interviewing also are discussed, as are the overall therapeutic goals when using this approach. Sources of the resistance between the therapist and client are reviewed, as well as specific recommendations for responding. The motivational interviewing approach to resistance is applied to each of the three case vignettes.

Adult↗
PubMed2002

Context-bound communication skills training: development of a new method.

OBJECTIVES: To examine how communication skills training might be integrated into everyday clinical practice in a manner that is acceptable to clinicians. DESIGN: General practitioners from 3 group practices agreed to take part, in turn, in a study of how to manage difficult consultations about antibiotic prescribing for acute respiratory infections. This provided the opportunity to conduct communication skills training in which lessons learned from one practice were taken into the next. SETTING: United Kingdom general practices. SUBJECTS: Three groups of general practitioners. FINDINGS: Difficulties with the acceptability of a traditional off-site workshop approach, using role play as the main teaching method, led to the development of a new training method (context-bound training), which proved to be practical and acceptable to experienced clinicians. The main features of the method were the delivery of training in the clinicians' place of work, and the transformation of their reported difficult cases into scenarios which they then encountered with a standardized simulated patient before and after brief seminars. Everyday clinical experience was kept in the foreground and 'communication skills' in the background. CONCLUSIONS: The method is acceptable to clinicians and adaptable to a range of clinical situations. It offers potential for improving the communication skills of clinicians both in hospital and primary care settings.

Communication↗
PubMed2002

Developing a new line of patter: can doctors change their consultations for sore throat?

BACKGROUND AND OBJECTIVES: Doctors report pressure from peers to reduce prescribing of antibiotics for minor respiratory illnesses, and from patients to do the opposite. It has been suggested that doctors adopt a more patient-centred consulting style in order to encourage patient satisfaction and shared decision-making. No evidence exists that such changes are achievable. We developed a new, on-site method for training postgraduates and used this for teaching patient-centred intervention. Here, we examine whether this training method is associated with changes in consulting patterns in consultations for sore throat with children, among doctors from a single group practice. METHODS: Audiotaped consultations (simulated and real) conducted before and after training were analysed and interviews were carried out with participants about the impact of training. SETTING: A general practice in South Wales. PARTICIPANTS: Four general practitioners who consulted with 25 real and simulated patients participated in the study. MAIN OUTCOME MEASURES: Four patient-centred skills used by doctors and 2 patient behaviours measured before and after training were identified. RESULTS: Three out of 4 practitioners produced clear evidence of changes in patient-centred consulting skills. These changes were evident in simulated and real consultations 2 and 4 weeks later, respectively. Prior to training the doctors produced only five examples of patient-centred skills in 10 consultations. After training they produced 39 examples in 15 consultations. CONCLUSIONS: Evidence from both consultations and interviews indicated that the intervention and training were well received and had been put into practice.

Communication↗