What if the patient doesn't want to talk about any of the areas highlighted?
It is about involving the patient in a conversation. It is not just about ticking boxes. You and the patient are both on the same side: you both have an interest in improving or maintaining their health.
Are there are any topics which are particularly relevant to the patient’s condition or circumstances take the opportunity to establish the patient’s knowledge. Are there any misconceptions that can be addressed?
If your patient is meeting all the recommendations or has recently made changes ask them to tell you what it is they are doing now or what differences they have noticed as a result of the changes they have made.
Re-enforcing the positive steps they have made can help to enhance motivation to stick with the changes.
An important feature that distinguishes a brief intervention from merely giving advice is the underlying principle that the patient is best placed to know their own circumstances and concerns, and therefore to decide what is best for them at any given time.
This principle leads to two key practice points for delivering brief interventions:
The practitioner should not try to push the person in a particular direction, but should adopt an objective approach and emphasise the patient’s freedom to make their own choices.
Argument should be avoided. If the person is interested, the practitioner can provide information to help them to make an informed decision, but the final choice should be that of the patient.
The practitioner should encourage the patient to take ownership of any decision to change their behaviour by challenging any statements the person makes which imply that they do not have a choice.
Please see Assess Readiness section for suggestions on how to progress the conversation depending on the patients readiness to change.