1. How to Give Advice to Patients Ambivalent toward Change
Michael A. Cucciare, PhD
Psychologist, Women’s Mental Health Program
University of Arkansas for Medical Sciences
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2. Today’s Goals
Discuss general challenges to effectively communicating with patients
Discuss practical suggestions for improving communication
Present a strategy for sharing information/giving advice to patients who are unsure about next steps

3. What do we mean by ambivalence?
Having mixed feelings about a course of action
Assumption is that motivation in malleable

5. General challenges to effectively communicating
Passivity
High emotion
Distraction
“Some patients seem to hear, but others, I tell them time and again and it never seems to sink again”
- anonymous

6. Practical suggestions for improving information exchange
Slow down, and progress will be quicker
Consider the broader priorities of the patient
Positive messages matter

7. A brief, motivational strategy for giving advice
Remember: If a patients asks for information/advice, go ahead and give it
If ambivalent, consider starting by asking permission (i.e., “knock on the door before you enter”)
Consider using Ask-Provide-Ask

9. Ask-Provide-Ask
Understand what is most important for the patient to know from their perspective
What would you most like to know about________?
Create an opportunity to correct misconceptions or misinformation
What do you already know about_________?

10. Ask-Provide-Ask Provide Give advice/information in a manageable chunk
Ask permission
Would it be ok if I shared some information with you about
_______?
Can talk about other patients’ experiences

11. Ask-Provide-Ask Check-in to see if the patient is getting what you say
Some possibilities include:
What are you thoughts/feelings about this?
What else would you like to know?
What questions do you have?
What do you think about this?
The focus is on not how much information you can get across but helping the patient make sense of the information and make good decisions about behavior

13. What to take away
For patients who are “not ready”, advice/information giving is optimized when you:
Convey respect for their decision-making autonomy (e.g., ask permission)
Provide information that is personalized and focused (e.g., find out what they want to know)
Assess the impact of information or advice (e.g., check in to see what they think)

14. Resources

15. Thank you!

16. Questions about the Topic
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17. Case Conference and Feedback
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