Managing Chronic Pain in an Opioid Crisis: What Is the Role of Shared Decision-Making?
Managing Chronic Pain in an Opioid Crisis: What Is the Role of Shared Decision-Making?
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DOI：
10.1080/10410236.2019.1625000
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发表时间：
2019-06-08
影响因子：
3.9
通讯作者：
Huffman, Monica A.
中科院分区：
文献类型：
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作者：
Matthias, Marianne S.;Talib, Tasneem L.;Huffman, Monica A.
共享决策（SDM）是一种广泛倡导的实践，与改善患者依从性、满意度和临床结局有关。SDM是一个过程，在这个过程中，患者和提供者共享信息，表达意见，并就治疗决策达成共识。慢性疼痛及其治疗对SDM提出了独特的挑战，特别是在目前阿片类药物被视为有害的环境中，并且已经宣布了国家阿片类药物危机。这项定性研究的目的是了解服用阿片类药物治疗慢性疼痛的患者的治疗决策。使用常数比较法分析了95个诊所访问和31个与患者和初级保健提供者（PCP）的访谈。结果显示：1）PCP希望患者参与治疗决策，但在阿片类药物方面存在警告; 2）关于阿片类药物的分歧，包括缺乏倾听的看法，对SDM提出了挑战;和3）PCP描述参与说服或谈判，以说服患者尝试阿片类药物的替代品，或者安抚要求使用非常少量阿片类药物的患者，以维持患者与提供者的关系。结果进行了讨论，通过透镜的查尔斯，加夫尼，和惠兰的SDM模型，并讨论了患者与供应商的关系中的作用和慢性疼痛治疗的影响。
Shared decision-making (SDM) is a widely-advocated practice that has been linked to improved patient adherence, satisfaction, and clinical outcomes. SDM is a process in which patients and providers share information, express opinions, and build consensus toward a treatment decision. Chronic pain and its treatment present unique challenges for SDM, especially in the current environment in which opioids are viewed as harmful and a national opioid crisis has been declared. The purpose of this qualitative study is to understand treatment decision-making with patients taking opioids for chronic pain. Ninety-five clinic visits and 31 interviews with patients and primary care providers (PCPs) were analyzed using the constant comparison method. Results revealed that 1) PCPs desire patient participation in treatment decisions, but with caveats where opioids are concerned; 2) Disagreements about opioids, including perceptions of lack of listening, presented challenges to SDM; and 3) PCPs described engaging in persuasion or negotiation to convince patients to try alternatives to opioids, or appeasing patients requesting opioids with very small amounts in an effort to maintain the patient-provider relationship. Results are discussed through the lens of Charles, Gafni, and Whelan's SDM model, and implications of the role of the patient-provider relationship in SDM and chronic pain treatment are discussed.