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P408. Motivational interviewing in inflammatory bowel disease patients: a useful tool during outpatient counselling

F. Mocciaro1, R. Di Mitri1, G. Russo1, S. Sferrazza1, S. Leone2, V. Quercia3, 1ARNAS Civico-Di Cristina-Benfratelli Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy, 2CEO of AMICI onlus, AMICI onlus, Palermo, Italy, 3Social Worker, MINT (Motivational Interviewing Network of Trainer), Rome, Italy

Background

Motivational interviewing (MI) is a patient-centered counselling style developed for eliciting behaviour change by helping patients (pts) to modify their lifestyle using. The strategy at the base of this approach is comprised of some basic skills: the ability to ask open ended questions, the ability to provide affirmations, the capacity for reflective listening, and the ability to periodically provide summary statements to the patients.

Methods

We report data on MI applied to all consecutive inflammatory bowel disease (IBD) pts referred for the first time to our outpatient clinic (Jun.'12-Feb.'13). We decided to supplement MI counselling using the aid of explanatory pictures. At the end of visit pts filled out a questionnaire, anonymously and in a separate room, comparing the visit with their prior experience.

Results

45 pts (23 males [51%], mean age of 36.1±15.2 yrs and median disease duration of 12 months [1–120]) were evaluated: 21 Crohn's disease (47%), 19 ulcerative colitis (42%), and 5 indeterminate colitis (11%); 67% of pts (30/45) were previously evaluated by a gastroenterologist while the remaining 33% (15/45) only by their general practitioner (GP). At final analysis only 60% of pts (27/45) reported a good overall satisfaction from their previous medical experiences. A complete dissatisfaction was observed in 11/30 pts (37%) previously evaluated by a gastroenterologist and in 7/15 pts (47%) evaluated only by their GP. Overall satisfaction rate before MI was significantly lower in pts affected by indeterminate colitis (p = 0.004) and in pts <40 years old (p = 0.02). Physicians' communication skills were reported quite satisfactory by female (p = 0.01) while poorly satisfactory in pts with family history of IBD (p < 0.001), in pts <40 years old (p < 0.001), and in pts affected by indeterminate colitis (p = 0.05). Concerning physician empathy perceived by pts it was strongly in female pts (p < 0.001) and lack in those with family history of IBD (p < 0.001). At multivariable analysis only good physician empathy perceived by female resulted significant (p = 0.002). After MI counselling all pts (100%) reported a good overall satisfaction without lack of empathy (71% marked “excellent empathy”) due to the fact that they felt they had complete answers to their questions. All pts appreciated the use of explanatory pictures. The mean duration of the visit was 41.5±8.7 minutes.

Conclusion

MI is very well appreciated by IBD pts. It is a quite time-consuming technique but considerably useful at the first visit and in younger pts. Explanatory pictures help pts to better understand their clinical condition. MI can help physicians, especially gastroenterologists, to move from “cure” to “care” with their IBD patients.