Table 6.

Rolling with Resistance: Confronting vs. Rolling

Confronting

Clinician: What have you heard about hospice?

Patient: My aunt was in hospice. It was terrible! All they wanted to do was give her that morphine. She died two days after she got into hospice, just because they were pushing that morphine on her.

Clinician (confronting): Actually, that's not what hospices are about. They only want to give you medications just to help your pain, not to hasten death.

Patient (angrily): I just know what I saw is all. I'm not going to give up and just go into some hospice.

Rolling with resistance

Clinician: What have you heard about hospice?

Patient: My aunt was in hospice. It was terrible! All they wanted to do was give her that morphine. She died two days after she got into hospice, just because they were pushing that morphine on her.

Clinician:(reflection) Your aunt's experience was not good. You wouldn't want that to happen to you.

Patient: Yeah, I don't want to be all doped up. That's all they do to you in that hospice.

Clinician:(reflection) It's pretty important to you that you have control and can decide whether and how you get medication.

Patient: Yeah. I want my pain controlled but I sure don't want to be drugged up.

Clinician: I want you to have good pain control too and to help you be awake and enjoying life as long as possible. In my experience the hospice I work with is pretty good at both those things so it might be different than the one your aunt had experience with. Would it be OK if I tell you a little more about it?

Patient: OK.

Clinician: In the hospice I work with the nurses work pretty closely with the patient to make sure that they are feeling as good as possible. If it is important for you to be awake and alert, that would be their goal too and they'd give you as much or as little medication as you wanted.

Patient: Hmmmm …. Well, does insurance cover it?