Motivational Interviewing

Motivational Interviewing

PEP Topic 
Fatigue
Description 

Motivational interviewing is a counseling style and way of being with an individual in which the counselor becomes a helper in the change process. The motivational interviewing style generally is founded in principles of the provision of empathy through reflective listening, identifying discrepancies between client goals, values, and current behavior, avoiding confrontation, adjusting to client resistance, the provision of support and optimism, and the enhancement of self efficacy. This style is aimed at helping clients to resolve ambivalence about behavior change. Motivational interviewing was examined for its effects on anxiety, depression, and fatigue in patients with cancer.

Effectiveness Not Established

Research Evidence Summaries

Ream, E., Gargaro, G., Barsevick, A., & Richardson, A. (2014). Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: Modeling and randomized exploratory trial. Patient Education and Counseling, 98, 199–206. 

doi: 10.1016/j.pec.2014.10.012
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Study Purpose:

To report on using a fatigue intervention adapted for telephone use and the findings of an exploratory controlled trial

Intervention Characteristics/Basic Study Process:

The Beating Fatigue intervention was delivered over the first three treatment cycles to patients starting chemotherapy. The intervention included fatigue education, fatigue assessment, self-care coaching, and emotional support. Participants were given an information packet, a fatigue diary, and a support nurse consultation with each treatment cycle. The modified version included a telephone consultation and motivation interviewing. The control group received usual care consisting of inquiring about fatigue levels. Phase 1 work was done to establish acceptability. In phase 2, patients were randomly assigned to intervention and control groups.

Sample Characteristics:

  • N = 44  
  • MEAN AGE = 53.3 years
  • MALES: 39%, FEMALES: 61%
  • KEY DISEASE CHARACTERISTICS: 59% breast, 32% lymphoma, and 9% colorectal
  • OTHER KEY SAMPLE CHARACTERISTICS: 68% white British

Setting:

  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Large cancer center in the United Kingdom

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

Mixed-method exploratory study; phase 1 to explore feasibility and acceptability of telephone-delivered version of intervention; phase 2 to measure treatment effect, patient acceptance, and treatment integrity

Measurement Instruments/Methods:

  • Brief Fatigue Inventory (BFI)
  • Fatigue Distress Scale (FDS)
  • Hospital Anxiety and Distress Scale (HADS)
  • Fatigue Self-Efficacy (FSE) scale 
  • Semi-structured interviews
  • There was no description of the instruments in the article, including measurement performance (e.g., reliability). Consequently, the full evaluation of the findings are not possible without information regarding instruments not commonly used in research (e.g., FDS, FSE).

Results:

Fatigue intensity decreased in the intervention group and increased in the control group (effect size [ES] = 0.18). Distress and anxiety decreased in the intervention group and increased in the control group (ES = 0.62, ES = 0.31, p = 0.05), and self-efficacy increased in the intervention group and decreased in the control group (ES = -0.34, p = 0.05). Depression increased in both groups slightly.

Conclusions:

Fatigue improvement was small based on the effect size. Interviews suggested the acceptance of telephone interventions by patients. Distress from fatigue was decreased for participants. The results of this study showed improvement in self-efficacy and anxiety with the intervention.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)

 

Nursing Implications:

This nurse-delivered intervention may improve patient distress associated with fatigue and reduce fatigue severity. Motivational interviewing might be helpful in managing anxiety. Additional research to develop this evidence is needed.

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