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，以改善初级保健中与疼痛相关的沟通、疼痛管理和阿片类药物处方

• 批准号: 9223594
• 负责人: Stephen G Henry
• 金额: $ 19.69万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9223594
• 关键词: Address; Agreement; Behavioral; Benzodiazepines; Cessation of life; Chronic; Clinic Visits; Clinical; Clip; Code; Communication; Communication Research; Data; Discipline; Dose; Drug Addiction; Educational Intervention; Epidemic; Face; Feedback; Fostering; Goals; Guidelines; Health; Health Communication; Individual; Intervention; Interview; Libraries; Link; Measures; Mediation; Medical; Mentors; Mission; Morphine; Opioid; Outcome; Overdose; Pain; Pain interference; Pain management; Participant; Patient Care; Patient Education; Patient risk; Patients; Perception; Performance; Pilot Projects; Play; Primary Health Care; Probability; Public Health; Questionnaires; Randomized; Reaction; Recommendation; Recruitment Activity; Reporting; Research; Research Activity; Research Personnel; Research Training; Resources; Risk; Role; Safety; Secure; Standardization; Substance Use Disorder; Test Result; Testing; Therapeutic; Training Activity; Treatment Efficacy; United States National Institutes of Health; Video Recording; Visit; addiction; base; chronic pain; cost; design; drug abuse prevention; experience; high risk; improved; instructor; lectures; meetings; non-cancer pain; opioid misuse; opioid use; overdose death; patient oriented; patient safety; prescription drug abuse; prescription opioid; programs; skills; therapy design; therapy development; treatment effect; treatment planning

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.

临床医生培训干预，以改善与疼痛相关的沟通、疼痛管理和阿片类药物 初级保健处方 项目概要/摘要 处方药滥用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 重新评估阿片类药物治疗慢性非癌性疼痛的用途。因此，临床医生面临着促进 安全开药，同时履行解决患者疼痛和维持积极治疗的义务 抽动关系对于在初级保健中实现最佳医疗结果至关重要。沟通 在阿片类药物处方（例如阿片类药物剂量和逐渐减量决定）和维持治疗中发挥着关键作用 和平关系。然而，患者和初级保健临床医生（他们开出的阿片类药物占所有阿片类药物的 65%）报告称 沟通不畅和临床互动困难是安全处方的最重要障碍 和有效的疼痛管理。该 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（训练有素的演员扮演患者角色）作为指导员的培训干预 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初级资料库 涉及使用阿片类药物治疗慢性疼痛的患者的护理访问，并正在系统地编码和分析与疼痛相关的 这些访问期间发表的声明。该库是识别有效沟通的独特资源 指导干预措施设计的策略，以促进有效的疼痛相关沟通（操作- 定义为缺乏高风险处方和患者对治疗计划的高度同意）。本项目的目标1 是开发一种基于经验的、可扩展的临床医生培训干预措施，以促进有效的沟通 关于初级保健中的疼痛和阿片类药物。为了实现这一目标，视频库中的发现将被审查以 识别显示假定有效和无效沟通实例的视频剪辑。初级保健诊所 然后，将采访患有慢性疼痛的医生和患者，以了解他们对这些视频剪辑和观察结果的反应。 获得关于沟通不良的原因和使沟通更有效的策略的反馈。间 视图结果将用于确认以患者为中心和针对特定疼痛的关键沟通技巧 标准化患者指导员干预的目标。目标 2 是进行干预试点随机对照试验 目标 1 中制定的目的是评估干预可行性并估计治疗效果以计划后续治疗 进行了一系列全动力、多站点 RCT。初级保健临床医生将随机接受干预措施 或控制；然后，48 名患者（每位临床医生 2 名）将在研究临床医生的就诊期间被记录下来，并将 提供有关访问后看法和健康结果的数据。研究假设是拜访临床医生 接受干预（相对于对照）的人将更频繁地使用有针对性的沟通 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 计划，并在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，专注于改善患者的 临床医生就初级保健中的疼痛和减少高风险阿片类药物处方进行沟通。