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.

临床医生培训干预措施，以改善与疼痛相关的沟通，疼痛管理和阿片类药物 在初级保健中开处方 项目摘要 /摘要 处方药滥用和阿片类药物相关的死亡率的提高使临床医生和政策制定者达到 重新评估使用阿片类药物治疗慢性非癌症疼痛。因此，临床医生面临促进的挑战 安全开处方同时还履行其解决患者疼痛并保持阳性疗法的义务 - 抽动关系，这对于在初级保健中实现最佳医学结果至关重要。沟通 在阿片类药物处方（例如阿片类药物的剂量和逐渐减少的决策）以及维持治疗方面都起着关键作用 猿类关系。然而，患者和初级保健临床医生（开处方65％的阿片类药物）报告说 沟通不良和困难的临床互动是安全处方的最重要障碍之一 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）的培训干预措施作为讲师 向初级保健临床医生传授沟通技巧。 PI收集了一个视频录制的主要库 涉及阿片类药物的患者进行慢性疼痛的护理探访，并且正在系统地编码和分析与疼痛有关 这些访问期间发表的陈述。该库是识别有效交流的独特资源 告知设计干预措施的策略，该干预措施促进有效的疼痛沟通（操作 - 由于缺乏与治疗计划的高风险开处方和高度同意的同意）。目标1 是开发基于经验的，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。为此，将对视频库中的发现进行审查 确定视频剪辑，显示了预先有效且无效的沟通实例。初级保健临床 然后，将对CIAN和慢性疼痛患者进行采访，以引起他们对这些视频片段的反应，并观察到 关于沟通不良和策略使沟通更有效的策略的反馈。互 查看发现将用于确认以患者为中心的关键和特定于疼痛的沟通技巧 由标准化的患者讲师干预针对。目标2是进行干预的飞行员RCT 在目标1中开发以评估干预可行性和估计治疗效果以计划 Quent完全动力的多站点RCT。初级保健临床医生将被随机接受干预 或控制；然后，将在研究临床医生的诊所就诊期间记录48例患者（每位临床医生2例），并将记录 提供有关参观后的看法和健康成果的数据。研究假设是与临床医生的访问 接受干预措施（与控制）的人将与更频繁地使用有针对性的通信 技术技能，高风险阿片类药物处方的概率较低，患者报告的同意与治疗 计划和降低疼痛干扰3个月后。该提案中计划的研究和培训活动 将为PI配备成为专注于改善患者的独立调查员所需的技能 - 临床医生在初级保健中就疼痛和减少高风险阿片类药物处方的沟通。