- Title
- Therapeutic alliance between dietitians and patients with head and neck cancer: The effect of training in a health behavior change intervention
- Creator
- Murray, Rebecca; Baker, Amanda; Halpin, Sean; Britton, Ben; McCarter, Kristen; Palazzi, Kerrin; Beck, Alison K.
- Relation
- Annals of Behavioral Medicine Vol. 53, Issue 8, p. 756-768
- Publisher Link
- http://dx.doi.org/10.1093/abm/kay083
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2019
- Description
- Background: The relationship between a clinician and their client - the "therapeutic alliance" is a robust predictor of outcome in healthcare settings; yet, few interventions to improve alliance have been tested. Motivational interviewing is a client-centered approach that embodies many principles and strategies consistent with a strong therapeutic alliance. Purpose: To examine whether alliance is enhanced by training dietitians to deliver a motivational interviewing informed health behavior change intervention ("Eating as Treatment"; EAT) as part of routine consultations with patients with head and neck cancer. The predictive ability of motivational interviewing techniques was also assessed. Methods: A secondary analysis of the EAT stepped-wedge cluster-randomized controlled trial was conducted. Patients with head and neck cancer undergoing radiotherapy (n = 307) were treated by radiotherapy dietitians (n = 29) during the control (Treatment as Usual) or intervention (EAT) phase. Alliance was rated during the first and final weeks of radiotherapy, and again 4 and 12 weeks post-radiotherapy. Dietetic sessions were audiotaped. Week one sessions were objectively rated for dietitians' use of motivational interviewing techniques. Results: Generalized linear-mixed effects regressions found no effect of EAT on dietitian-rated alliance (p =. 237). After excluding outliers, patient-rated alliance was 0.29 points lower after EAT training (p =. 016). Post hoc analyses revealed lower patient ratings on perceived support and dietitian confidence. Hierarchical multiple regressions found that no specific motivational interviewing techniques predicted patient-rated alliance. Dietitian acknowledgment of patient challenges was related to dietitian-rated alliance (β =.15, p =.035). Conclusions: Patient and dietitian ratings of alliance were high after EAT training, but not significantly improved. Further research is needed to better understand the differential impact of intervention training and delivery on patient and clinician ratings of therapeutic alliance.
- Subject
- alliance; motivational interviewing; cancer; nutrition; eating as treatment; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1451773
- Identifier
- uon:44268
- Identifier
- ISSN:0883-6612
- Rights
- © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Behavioral Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
- Language
- eng
- Full Text
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