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.

利用患者的叙述来促进初级保健中阿片类药物的逐渐减少 项目概要/摘要 在过去的二十年中，阿片类药物用于治疗慢性疼痛的增加导致严重阿片类药物的使用迅速增加。 相关伤害，包括死亡，但没有明确证据表明任何相应的患者受益。如此多 因慢性疼痛而服用阿片类药物的患者（其中最大的群体是患有慢性颈部和/或腰部疼痛的患者） 疼痛）需要逐渐减少或降低到更安全的剂量。开处方的患者和初级保健临床医生 大多数阿片类药物用于治疗慢性疼痛，两者都报告说阿片类药物逐渐减少是一个困难且充满争议的话题 通过频繁的分歧。因此，迫切需要采取干预措施来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量，同时维持所需的治疗关系 为患者的其他医疗问题提供最佳护理。 R21 的总体假设是有说服力的 显示真实患者讲述有关阿片类药物逐渐减少的个人故事的视频可用于设计 有效的患者干预以提高阿片类药物的逐渐减少率。基于故事的干预措施已经制定 对于其他临床问题，如果所使用的故事有说服力，则可能对阿片类药物逐渐减少有效 查看它们的患者。该提案的总体目标是 a) 填补有关患者的知识空白 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故事，总体而言 以及按性别和公共健康保险与私人健康保险定义的患者亚组，以及 c) 告知设计 阿片类药物逐渐减少干预措施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/或腰痛的患者，这些患者已被推荐、正在接受或 最近完成了阿片类药物的减量。他们将参加一系列旨在激发他们的兴趣的焦点小组 以个人故事的形式逐渐减少的经历。每组中选出 2-3 位最引人注目的讲故事者 将被识别并要求返回进行单独的视频采访，在此期间他们将重新讲述他们的情况 关于逐渐减少的个人故事。另外 48 名因慢性颈部或腰痛而服用阿片类药物的患者 （按性别以及私人健康保险与公共健康保险分层）然后将观察并提供反馈 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，确定 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。的评级 将分析说服力以及主题内容和患者评论，以确定哪些故事 最具说服力并探索患者亚组之间的差异。该提案将导致 识别患者认为非常有说服力的有关逐渐减量的故事，因此可以构成治疗的基础 创新的、基于故事的逐渐减少干预。拟议的研究还将生成有关招聘的数据， 可行性，以及未来 R01 提案的最佳目标人群。该提案提出了一系列 研究将产生创新的干预措施，以促进初级保健中阿片类药物的逐渐减少，长期 减少慢性疼痛患者处方阿片类药物滥用和阿片类药物相关危害的长期目标。