Harnessing patient narratives to promote opioid tapering in primary care

利用患者叙述促进初级保健中阿片类药物的逐渐减少 项目摘要/摘要 在过去的二十年里，越来越多的阿片类药物用于慢性疼痛，导致严重的阿片类药物迅速上升- 相关伤害，包括死亡，但没有明确证据表明任何相应的患者利益。如此之多 服用阿片类药物治疗慢性疼痛的患者(其中最大的群体是慢性颈部和/或腰部疼痛的患者 疼痛)需要逐渐减少或减少到更安全的剂量。病人和初级保健临床医生，他们开出处方 大多数阿片类药物治疗慢性疼痛，两者都报告说，阿片类药物逐渐减少是一个困难和充满压力的话题 因为频繁的分歧。因此，迫切需要促进富有成效的讨论的干预措施。 关于阿片类药物，并说服患者开始缩减治疗，同时保持所需的治疗关系 为患者的其他医疗问题提供最佳护理。R21的首要假设是有说服力 显示真实患者讲述他们关于阿片类药物逐渐减少的个人故事的视频可以用来设计一种 有效的患者干预，以提高阿片类药物的减少率。已经开发了基于故事的干预措施 对于其他临床问题，如果所使用的故事具有说服力，则可能对阿片类药物的逐渐减少有效 看过这些照片的病人。这项提议的总体目标是：a)填补关于病人的知识空白 阿片类药物逐渐减少的经历，b)确定患者认为有说服力的视频记录的故事，两者总体上 对于按性别和公共医疗保险与私人医疗保险定义的患者亚组，以及c)信息设计 阿片类药物逐渐减少的干预，可以在未来的临床试验中进行测试。研究参与者将是主要的 护理患有慢性颈部和/或下腰痛的患者，他们已被推荐治疗，正在接受治疗，或 最近完成了阿片类药物的缩减。他们将参加一系列的焦点小组，旨在引发他们的 以个人故事的形式提供了缩减的经验。每组2-3名最有说服力的故事家 将被确认并被要求回来接受单独的录像采访，在此期间，他们将重新告诉他们的 关于缩减的个人故事。48名额外服用阿片类药物治疗慢性颈或下腰痛的患者 (按性别和私人与公共医疗保险分层)然后将观看并提供反馈 在这些采访中记录的个别故事。他们将对每个故事的总体说服力进行评级，确定 讨论的主题，并评论为什么他们认为每个故事都有说服力或没有说服力。收视率 说服力以及主题内容和耐心评论将被分析，以确定 是最有说服力的，并探索不同患者亚群的差异。这项提议将导致 确定患者认为具有很强说服力的有关缩减的故事，从而形成 创新的、以故事为基础的缩减干预措施。拟议的研究还将产生有关招聘的数据， 可行性，以及未来R01提案的最佳目标人口。这项提案提出了一系列 研究将导致一种创新的干预措施，以促进初级保健中阿片类药物的逐渐减少，长期- 减少处方阿片类药物滥用和慢性疼痛患者的阿片类药物相关危害的长期目标。

Harnessing patient narratives to promote opioid tapering in primary care Project Summary / Abstract Over the past two decades, increased opioid use for chronic pain has led to a rapid rise in serious opioid- related harms, including death, without clear evidence of any corresponding patient benefit. Thus many patients on opioids for chronic pain (the largest group of which are patients with chronic neck and/or low back pain) need to be tapered either off or down to safer doses. Patients and primary care clinicians, who prescribe the majority of opioids for chronic pain, both report that opioid tapering is a difficult and charged topic marked by frequent disagreements. Thus, there is a critical need for interventions that facilitate productive discussions about opioids and persuade patients to initiate tapering while maintaining the therapeutic relationship needed for optimal care of patients' other medical problems. The overarching hypothesis for this R21 is that persuasive videos showing real patients telling their personal stories about opioid tapering can be used to design an effective patient intervention to increase opioid tapering rates. Story-based interventions have been developed for other clinical problems and are likely to be effective for opioid tapering if the stories used are persuasive to the patients who view them. The overall goals of this proposal are to a) fill a knowledge gap about patients' experiences with opioid tapering, b) identify video-recorded stories that patients find persuasive, both overall and for patients subgroups defined by gender and public versus private health insurance, and c) inform design of an opioid tapering intervention that can be tested in a future clinical trial. Study participants will be primary care patients with chronic neck and/or low back pain who have been recommended for, are undergoing, or have recently finished an opioid taper. They will participate in a series of focus groups designed to elicit their experiences with tapering in the form of personal stories. The 2-3 most compelling storytellers from each group will be identified and asked to return for individual video-recorded interviews, during which they will re-tell their personal stories about tapering. Forty-eight additional patients on opioids for chronic neck or low back pain (stratified by gender and by private versus public health insurance) will then watch and give feedback on the individual stories recorded during these interviews. They will rate each story's overall persuasiveness, identify the topics discussed, and comment on why they found each story persuasive or not. Ratings of persuasiveness as well as thematic content and patient comments will be analyzed to identify the stories that are most persuasive and to explore differences across patient subgroups. This proposal will result in identification of stories about tapering that patients find highly persuasive and so can form the basis for an innovative, story-based tapering intervention. The proposed research will also generate data on recruiting, feasibility, and the optimal target population for a future R01 proposal. This proposal advances a line of research that will result in an innovative intervention to facilitate opioid tapering in primary care, with the long- term goal of reducing prescription opioid misuse and opioid-related harms among patients with chronic pain.