A clinician training intervention to improve pain-related communication, pain management and opioid prescribing in primary care

临床医生培训干预，以改善疼痛相关的沟通，疼痛管理和阿片类药物 初级保健处方 项目总结/摘要 处方药滥用率和阿片类药物相关死亡率的上升导致临床医生和政策制定者 重新评估使用阿片类药物治疗慢性非癌症疼痛。因此，临床医生面临的挑战，促进 安全处方，同时也履行他们的义务，以解决病人的痛苦和保持积极的治疗eu， 这些关系对于在初级保健中实现最佳医疗结果至关重要。通信 在阿片类药物处方（例如，阿片类药物剂量和逐渐减少的决定）和维持治疗- 不稳定的关系。然而，患者和初级保健医生（他们开了65%的阿片类药物）报告说， 沟通不畅和临床互动困难是安全处方的最重要障碍 有效的疼痛管理。本K23提案的总体目标是开发和试点测试临床医生 使用标准化患者（扮演患者角色的训练有素的演员）作为指导者的培训干预， 向初级保健临床医生传授沟通技巧。PI收集了一个视频记录的主要图书馆 涉及阿片类药物治疗慢性疼痛的患者的护理访问，并系统地编码和分析疼痛相关的 在这些访问期间发表的声明。这个图书馆是一个独特的资源，用于识别有效的沟通 为干预设计提供信息的策略，以促进有效的疼痛相关沟通（操作- 被定义为没有高风险处方和患者对治疗计划的高度同意）。项目目标1 是开发一种基于实践的、可扩展的临床医生培训干预措施，以促进有效的沟通 疼痛和阿片类药物在初级保健中的应用为了做到这一点，将审查视频库的调查结果， 识别显示有效和无效沟通的视频剪辑。初级保健诊所- 医生和慢性疼痛患者将接受采访，以了解他们对这些视频剪辑的反应， 收集关于沟通不良原因和使沟通更有效的战略的反馈。内部 视图结果将用于确认关键的以患者为中心和疼痛特异性沟通技能， 标准化患者指导员干预的目标。目标2是进行干预的试点RCT 目的1中制定的，以评估干预可行性和估计治疗效果，以计划一个亚组， 全功率多站点RCT。初级保健临床医生将随机接受干预措施 或对照;然后在临床访视期间记录48例患者（每名临床医生2例），并将 提供关于就诊后的看法和健康结果的数据。研究假设是， 接受干预（与对照组相比）的患者将更频繁地使用有针对性的通信， 操作技能，高风险阿片类药物处方的可能性较低，患者报告的治疗一致性较高 3个月后，降低疼痛干扰。本提案中计划的研究和培训活动 将使PI具备成为独立研究者所需的技能，专注于改善患者- 临床医生沟通疼痛和减少高风险阿片类药物处方在初级保健。

A clinician training intervention to improve pain-related communication, pain management and opioid prescribing in primary care Project Summary / Abstract Increasing rates of prescription drug abuse and opioid-related deaths have led clinicians and policymakers to re-evaluate the use of opioids to treat chronic non-cancer pain. Clinicians thus face the challenge of promoting safe prescribing while also meeting their obligation to address patients' pain and maintaining positive therapeu- tic relationships, which are critical for achieving optimal medical outcomes in primary care. Communication plays a key role in both opioid prescribing (e.g., opioid dosing and tapering decisions) and in maintaining ther- apeutic relationships. Yet patients and primary care clinicians (who prescribe 65% of all opioids) report that poor communication and difficult clinical interactions are among the most important barriers to safe prescribing and effective pain management. The overall goal of this K23 proposal is to develop and pilot test a clinician training intervention that uses standardized patients (trained actors playing patient roles) as instructors who impart communication skills to primary care clinicians. The PI has collected a library of video-recorded primary care visits involving patients on opioids for chronic pain and is systematically coding and analyzing pain-related statements made during these visits. This library is a unique resource for identifying effective communication strategies to inform the design of an intervention that fosters effective pain-related communication (operational- ized as absence of high-risk prescribing and high patient agreement with treatment plans). Aim 1 of this project is to develop an empirically-based, scalable clinician training intervention to promote effective communication about pain and opioids in primary care. To accomplish this, findings from the video library will be reviewed to identify video clips showing instances of putatively effective and ineffective communication. Primary care clini- cians and patients with chronic pain will then be interviewed to elicit their reactions to these video clips and ob- tain feedback on causes of poor communication and strategies to make communication more effective. Inter- view findings will be used to confirm key patient-centered and pain-specific communication skills that will be targeted by the standardized patient instructor intervention. Aim 2 is to conduct a pilot RCT of the intervention developed in Aim 1 in order to evaluate intervention feasibility and estimate treatment effects to plan a subse- quent fully-powered, multisite RCT. Primary care clinicians will be randomized to receive either the intervention or control; 48 patients (2 per clinician) will then be recorded during clinic visits with study clinicians and will provide data on post-visit perceptions and health outcomes. Study hypotheses are that visits with clinicians who receive the intervention (versus control) will be associated with more frequent use of targeted communica- tion skills, lower probability of high-risk opioid prescribing, higher patient-reported agreement with treatment plan, and lower pain interference 3 months later. The planned research and training activities in this proposal will equip the PI with the skills required to become an independent investigator focused on improving patient- clinician communication about pain and decreasing high-risk opioid prescribing in primary care.