Harnessing patient narratives to promote opioid tapering in primary care

利用患者的叙述来促进初级保健中阿片类药物的逐渐减少

• 批准号: 9304166
• 负责人: Stephen G Henry
• 金额: $ 19.63万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9304166
• 关键词: Acute; Adverse effects; Affect; Benzodiazepines; Cessation of life; Charge; Chronic; Clinical; Clinical Trials; Conflict (Psychology); Consumption; Data; Discipline; Dose; Drug Addiction; Epidemic; Feedback; Focus Groups; Fright; Future; Gender; Goals; Health Insurance; Hypertension; Individual; Insurance; Intervention; Interview; Knowledge; Lead; Low Back Pain; Medical; Mental disorders; Mission; Modeling; Neck; Opiate Addiction; Opioid; Pain; Participant; Patient Care; Patient Recruitments; Patients; Pattern; Primary Health Care; Privatization; Public Health; Published Comment; Recruitment Activity; Reporting; Research; Resources; Risk; Self Management; Series; Services; Socioeconomic Status; Specialist; Structure; Subgroup; Target Populations; Testing; Therapeutic; United States National Institutes of Health; Withdrawal; Withdrawal Symptom; Work; base; blood pressure regulation; chronic pain; design; drug abuse prevention; experience; high risk; improved; innovation; opioid misuse; opioid use; overdose death; patient safety; prescription drug abuse; prescription opioid misuse; programs; theories; therapy design; willingness

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.

利用患者叙述促进初级保健中的阿片类药物减量 项目总结/摘要 在过去的二十年里，阿片类药物用于慢性疼痛的增加导致严重阿片类药物的迅速增加， 相关伤害，包括死亡，没有明确证据表明任何相应的患者受益。因此许多 接受阿片类药物治疗慢性疼痛的患者（其中最大的一组是患有慢性颈部和/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。开处方的患者和初级保健临床医生 大多数阿片类药物治疗慢性疼痛，都报告说阿片类药物逐渐减少是一个困难和收费的话题， 频繁的分歧。因此，迫切需要采取干预措施，促进富有成效的讨论 关于阿片类药物，并说服患者开始逐渐减少，同时保持所需的治疗关系 以最佳方式治疗患者的其他医疗问题。R21的总体假设是， 显示真实的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于设计一个 有效的患者干预，以增加阿片类药物减量率。已经制定了基于故事的干预措施 对于其他临床问题，如果使用的故事有说服力， 看过的病人。该提案的总体目标是：a）填补有关患者 阿片类药物逐渐减少的经验，B）确定患者认为有说服力的视频记录的故事， 以及按性别和公共与私人健康保险定义的患者亚组，以及c）知情设计 阿片类药物逐渐减少干预，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 已被推荐治疗、正在接受治疗或正在接受治疗的慢性颈部和/或腰痛患者的护理 最近完成了阿片类药物的减量他们将参加一系列的焦点小组， 以个人故事的形式讲述逐渐减少的经历。每组选出2-3位最引人注目的故事讲述者 将被确定，并要求返回个人录像采访，在此期间，他们将重新讲述他们的 关于逐渐减量的个人故事另外48名患者因慢性颈部或腰痛接受阿片类药物治疗 （按性别和私人与公共医疗保险分层）将观察并提供反馈， 在这些采访中记录的个人故事。他们将评估每个故事的整体说服力， 讨论的主题，并评论为什么他们认为每个故事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的评论将被分析，以确定故事， 是最有说服力的，并探讨患者亚组之间的差异。这一提议将导致 确定患者认为非常有说服力的关于逐渐减少的故事，因此可以形成 创新的、基于故事的逐渐减量干预。拟议中的研究还将产生关于招聘的数据， 可行性，以及未来R 01提案的最佳目标人群。该提案提出了一条 研究将导致一种创新的干预措施，以促进阿片类药物逐渐减少在初级保健，与长期- 长期目标是减少慢性疼痛患者中处方阿片类药物滥用和阿片类药物相关危害。