Ambivalence: Motivational Interviewing Informed Communication for Serious Illness Care

Patients facing serious illness may experience ambivalence about important treatment decisions, sharing information with loved ones, or, perhaps most consequentially, living in a way that is aligned with their values. Motivational interviewing (MI) is a collaborative, person-centered communication style that explores ambivalence by eliciting a patient's motivations, values, and goals. MI offers a practical framework for serious illness communication (SIC), when patients and families often experience competing priorities and uncertainty. Through a clinical case, this article explores the four fundamental processes of MI-engaging, focusing, evoking, and planning-and reframes these concepts through a SIC lens. We highlight the application and adaptation of micro-skills (open-ended questions, affirmations, reflective listening, and summaries) to deepen understanding, explore ambivalence, and support values-concordant decision making. Integrating MI-informed communication strategies into serious illness care provides clinicians with practical tools to navigate ambivalence, foster collaboration, and evoke a patient's intrinsic motivation for decisions aligned with their values.