Patient is a 16 year-old male chronic parenteral nutrition dependence secondary to short bowel syndrome secondary to atresia. Despite several intestinal lengthening procedures at your center, he continues to receive the vast majority of his nutrition intravenously. Family complains that frequent in-depth clinic visits are interfering with quality of life. Family has an a consistent record of coming to ambulatory visits as scheduled.
What is the most appropriate next step?
A. Consult social work to develop a patient contract for non-compliance.
B. Offer to transfer care to an adult HPN provider within the next 6 months.
C. Provide education about the dangers associated with long-term HPN complications.
D. Offer less frequent visits with intermittent phone calls (non-standard practice) in order to maintain relationship.
E. Motivational interviewing to explore how frequent concerns about quality of life.
The correct answer is E. Motivational interviewing to explore how frequent concerns about quality of life. This technique improves the patient’s intrinsic motivation to change by exploring their perspective and ambivalence. In contrast to traditional strategies like confrontation, counseling, and emphasizing medical authority, motivational interviewing centers on the patient’s autonomy and collaboration.
Erickson SJ, Gerstle M, Feldstein SW. Brief interventions and motivational
interviewing with children, adolescents, and their parents in pediatric health care settings: a review. Arch Pediatr Adolesc Med. 2005 Dec;159(12):1173-80. Review. PubMed PMID: 16330743.