A mixed methods study of patient-provider communication about opioid analgesics
A mixed methods study of patient-provider communication about opioid analgesics
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DOI：
10.1016/j.pec.2014.12.003
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发表时间：
2015-04-01
影响因子：
3.5
通讯作者：
Beach, Mary Catherine
中科院分区：
文献类型：
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作者：
Hughes, Helen Kinsman;Korthuis, Philip Todd;Beach, Mary Catherine
目的：描述阿片类止痛药的患者与提供者之间的沟通，并探讨这些讨论如何影响提供者对患者的态度。方法：我们在全国4个地点对45名HIV提供者和423名患者进行了常规门诊接触的录音。提供者完成了访问后的问卷调查，评估了他们对患者的态度。我们确定了关于阿片类疼痛管理的讨论，并对其进行了定性分析。我们使用Logistic回归来评估阿片类药物讨论与提供者对患者的态度之间的关系。结果：48次接触(占总样本的11%)包含关于阿片类药物相关疼痛管理的实质性讨论。大多数对话由患者发起(n=28，58%)，由提供者结束(n=36，75%)。12次遭遇(25%)包含对话，暗示意见不同或存在冲突。提供者更多的是同意而不是不同意开处方(50%比23%)，有时是不情愿的；在27%(n=13)的遭遇中，没有做出决定。不到一半的提供者(n=20，42%)承认患者的疼痛经历。当讨论阿片类药物时，提供者对患者的正面评价的几率较低(调整后的OR=.0.51，95%CI：0.27-0.95)。结论：在常规的门诊HIV接触中，疼痛管理讨论很常见，提供者可能对患者的关注较少。如果在探视期间讨论阿片类药物，那就更好了。这些讨论有时的对抗性可能会对提供者对患者的态度产生负面影响。实践含义：同理心和疼痛认知是临床医生可以用来促进疼痛管理的富有成效的讨论的工具。(C)2015爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients.Methods: We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients.Results: 48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n = 28, 58%) and ended by the providers (n = 36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n = 13) of encounters, no decision was made. Fewer than half of providers (n = 20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR =.0.51, 95% Cl: 0.27-0.95) when opioids were discussed.Conclusions: Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less. favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients.Practice implications: Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management. (C) 2015 Elsevier Ireland Ltd. All rights reserved.