Decision-Making Factors for Therapeutic Opioid Use after Emergency Care

项目总结/摘要 这个职业发展奖将提供必要的教学和经验培训和指导， 候选人成为一个独立的和完全资助的卫生服务研究人员，专注于发展 和测试以健康为导向的急诊科战略，以改善初级和二级预防 物质使用障碍（SUD）该研究计划特别关注阿片类药物使用的流行 疾病（OUD），由主要是医源性的事件OUD引起（即，处方阿片类药物导致 OUD，尽管其被直接用于治疗目的）。指导方针和立法针对 提供者处方，但患者在治疗决策中的作用尚未得到解决 直接.有一个迫切和迫切需要了解影响病人的动机的因素 寻求和/或使用阿片类药物，并让他们作为利益相关者参与疼痛和OUD风险的平衡。 急诊科（ED）一直是阿片类药物处方干预的主要对象，因为它们 经常开始或继续使用治疗性阿片类药物，并在提供者-患者很少的情况下这样做 熟悉或后续护理。本研究的目的是测量和模型之间的关联艾德 患者决策因素（知识、态度、信念和感知）和患者使用动机 阿片类药物缓解疼痛或避免OUD风险。中心假设是艾德患者对治疗的渴望 阿片类药物和决定使用它们时，从潜在的可修改的认知因素的结果。我们将 采用焦点小组、横断面定量调查和 急性疼痛艾德访视后阿片类药物寻求和治疗使用的纵向随访， 以下目标：1）建立对影响患者使用动机的认知因素的定性理解 阿片类药物用于急性疼痛; 2）制定使用阿片类药物的决定（DTO）调查工具，以量化潜在的 患者使用阿片类药物治疗急性疼痛动机的认知决定因素;包括2a） DTO，以及2b）测量认知因素对患者寻求/使用阿片类药物的动机的贡献。 这将通过告知共同的决策，促进医源性OUD领域的高度影响力的进步- 制作模型和新的行为干预。该研究计划也是对 一个独立的临床研究人员的职业发展，专注于发展的主要和 在艾德环境中的二级SUD预防策略，提供混合方法的经验，纵向 前瞻性临床研究、调查验证和预测建模，以及丰富的初步数据， 在高素质和多学科导师团队的指导下支持未来的调查。的 这项研究的典型贡献将是让患者参与帮助平衡 疼痛未缓解，有后续OUD的风险。

PROJECT SUMMARY/ABSTRACT This career development award will provide didactic and experiential training and mentorship necessary for the candidate to become an independent and fully-funded health services researcher focused on the development and testing of health-oriented emergency department strategies to improve primary and secondary prevention of substance use disorders (SUD). The research plan focuses specifically on the epidemic of opioid use disorder (OUD), fueled by incident OUD which has been largely iatrogenic (i.e., prescribed opioids leading to OUD despite being used as directed for therapeutic purposes). Guidelines and legislation have targeted provider prescribing, but the role of the patients in therapeutic decision-making has not been addressed directly. There is an urgent and imperative need to understand factors influencing patients' motivation to seek and/or use opioids and engage them as stakeholders in the balance of pain and OUD risk. Emergency departments (EDs) have been a prime subject of opioid prescribing interventions, because they frequently initiate or continue therapeutic opioids and do so in circumstances with little provider-patient familiarity or follow-up care. The objective of this study is to measure and model associations between ED patient decision-making factors (knowledge, attitudes, beliefs, and perceptions) and patient motivation to use opioids for pain relief or avoid OUD risk. The central hypothesis is that ED patients' desire for therapeutic opioids and decision to use them when available results from potentially modifiable cognitive factors. We will conduct a mixed-methods study using a combination of focus groups, cross-sectional quantitative survey, and longitudinal follow-up of opioid seeking and therapeutic use after ED visit for acute pain to accomplish the following aims: 1) Establish a qualitative understanding of cognitive factors influencing patient motivation to use opioids for acute pain; 2) Develop the Decisions To use Opioids (DTO) survey instrument to quantify potential cognitive determinants of patient motivation to use opioids for acute pain; including 2a) Psychometric testing of the DTO, and 2b) Measure the contribution of cognitive factors to patient motivation to seek/use opioids. This will promote highly impactful advances in the field of iatrogenic OUD, by informing shared decision- making models and new behavioral interventions. The research plan is also highly complementary to the career development of an independent clinical researcher focused on the development of primary and secondary SUD prevention strategies in the ED setting, providing experience in mixed-methods, longitudinal prospective clinical research, survey validation, and predictive modeling, as well as rich preliminary data to support future investigation under the direction of a highly qualified and multidisciplinary team of mentors. The quintessential contribution of this research will be to engage the patient in helping to balance the risk of unrelieved pain with the risk of subsequent OUD.