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Table 2 Navigation techniques: example conversation excerpts *

From: The AViKA (Adding Value in Knee Arthroplasty) postoperative care navigation trial: rationale and design features

Developing goals:  
Eliciting ambivalence “Getting to the gym has been very challenging now that you've returned to work! You mentioned that you would like to get to the gym more often – why is that?”
Discussing established goals  
Confidence ruler “On a scale of 1 to 10, how confident are you that you can walk without a cane?”
  “Why did you rate yourself at [X] rather than a [lower number]?”
Asking about potential barriers “What challenges do you anticipate as you start thinking about returning to golf?”
Patient is discouraged and/ or did not achieve goal  
Affirmation and encouragement “I'm sorry to hear that you had to go to the hospital this week for pneumonia - I'm so glad you're feeling better! Despite the interruption to your recovery, it's wonderful that you achieved 108 degrees of flexion. Last time we spoke you were at 100 degrees – this is a huge improvement!”
In response to clinical concerns +  
Referral to appropriate clinician “It sounds like you're dealing with a lot of swelling in the knee and want a sense of whether that is normal. Did you mention this to the physical therapist today? What did he/she have to say?”
  “You're having new sharp pains in the knee. Have you considered speaking your surgeon and his/her team? If you would like, I can provide you with the number.”
Throughout conversation  
Asking permission “Do you mind if I ask why you originally decided to go through with the surgery?”
Open-ended questions “Where would you like to see yourself one week from now?”; “How have your exercises been going the last few weeks?”
Simple and complex reflection “It sounds like the flexion exercises are the most difficult for you and the pain is tremendous. At the same time, I'm hearing that you feel these are the most important for your recovery. Can you tell me more about the benefits of these exercises?”
Summarization “I'm so happy to hear that since we last spoke your flexion has improved, and you've felt comfortable cutting back on the pain medications. It sounds like you feel ready for the transition to outpatient therapy. Swelling is still making improvement difficult for you, but icing and elevation have been helping, and you hope to continue that through the next week. I look forward to speaking with you next week and hearing how things go as you continue to practice your gait and try walking outside for the first time! Do you have any questions or anything else you'd like to discuss today?”
  1. *All techniques, except “referral to appropriate clinician” were informed by the principles of motivational interviewing.
  2. +Navigators were trained to recognize symptoms of serious adverse events (such as infection or pulmonary embolus), and were to instruct the patient to dial 911 in such cases.