Identifying Communicative Factors Affecting Opioid Management for Chronic Pain

描述(申请人提供)：近几十年来，阿片类药物在慢性非癌症疼痛(CNCP)治疗中的使用和误用急剧增加。我们的主要假设是，患者和他们的医生之间的开放沟通，包括讨论阿片类药物是否是患者的最佳治疗方法，阿片类药物的风险和好处，以及阿片类药物监测策略将减少阿片类药物滥用的可能性。然而，有充分记录的慢性疼痛患者和他们的医生之间的沟通问题破坏了这些努力。鉴于阿片类药物在副作用和滥用方面的相关风险，患者和医生就阿片类药物的风险和益处进行有效的沟通和决策至关重要。我们的长期目标是为医生开发和测试量身定制的干预措施，以改善他们与患者关于阿片类药物治疗的沟通。这项先导性研究的目的是确定CNCP患者及其医生用来管理阿片类药物的沟通策略。我们将进行一项纵向观察性研究，在3次初级保健门诊就诊过程中，我们将对36名患者进行录音，这些患者服用了CNCP的阿片类药物。我们将对录音进行编码，以探索和验证患者的担忧、疼痛评估的深度以及共享决策-关键的以患者为中心的沟通变量。我们还将对患者进行深入的定性访谈和刺激回忆会议，以确定和描述医生沟通的十字架质量，CNCP患者认为这些质量对于有效的疼痛和阿片类药物治疗非常重要。相关性：用于治疗慢性疼痛的阿片类药物可能导致滥用、严重的医疗并发症，甚至死亡。2009-2010年，500多万美国人报告在过去一个月中将阿片类药物用于非医疗目的。2008年，阿片类镇痛剂导致近15,000人死亡--超过海洛因和可卡因。为CNCP发现成功的阿片类药物管理战略并将这些战略付诸实践是一项公共优先事项。

DESCRIPTION (provided by applicant): Opioid use and misuse in the treatment of chronic non-cancer pain (CNCP) has increased dramatically in recent decades. Our primary hypothesis is that open communication between patients and their physicians that includes discussions about whether opioids are the best treatment for a patient, the risks and benefits of opioids, and opioid monitoring strategies will reduce the potential for opioid misuse. However, well-documented communication problems between patients with chronic pain and their physicians undermine these efforts. Given the risks associated with opioids, both in terms of side effects and misuse, it is critical for patients and physicians to engage in effective communication and decision-making about the risks and benefits of opioids. Our long-term goal is to develop and test tailored interventions for physicians to improve their communication with patients about opioid treatment. The purpose of this pilot study is to identify communication strategies patients with CNCP and their physicians use to manage opioids. We will conduct a longitudinal observational study in which we will audio-record 36 patients, who have been prescribed opioids for CNCP, over the course of 3 primary care clinic visits. We will code the recordings for exploring and validating patient concerns, for the depth of pain assessment, and for shared decision-making - key patient-centered communication variables. We will also conduct in-depth qualitative interviews and stimulated recall sessions with patients to identify and describe crucia qualities of physician communication that patients with CNCP believe are important for effective pain and opioid management. Relevance Opioids prescribed to manage chronic pain can lead to misuse, serious medical complications, and even death. In 2009-2010, over 5 million Americans reported using opioids for non-medical purposes in the past month. In 2008, opioid analgesics were involved in nearly 15,000 deaths-more than from heroin and cocaine. It is a public priority to discover successful opioid management strategies for CNCP and to translate these strategies into practice.