Brief report: Training internists in shared decision making about chronic opioid

Sullivan, Mark D.; Leigh, Janis; Gaster, Barak

doi:10.1111/j.1525-1497.2006.00352.x

Cited by 80 publications

(105 citation statements)

References 16 publications

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“…Training providers in empathy, a positive aspect of pain care cited in this study, may be especially helpful in CNCP care [42,43]. Novel approaches to training providers and medical students in shared decision making and affective skills improves provider satisfaction, relationships, and interest in caring for patients with pain [44,45]. Providers described feeling rewarded when they were able to alleviate suffering and provide comfort to patients, and see them regain functionality and have improved well-being.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

Lincoln

Pellico²,

Kerns³

et al. 2013

J Palliative Care Med

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Objectives: Most patients with chronic non-cancer pain (CNCP) are cared for, by primary care providers (PCPs). While some of the barriers faced by PCPs have been described, there is little information about PCPs' experience with factors that facilitate CNCP care. Design:The study design was descriptive and qualitative. Data were analyzed using qualitative content analysis. Krippendorff's thematic clustering technique was used to identify the repetitive themes regarding PCPs' experiences related to CNCP management. Subjects:Respondents were PCPs (n=45) in the VA Connecticut Healthcare System in two academically affiliated institutions and six community based sites.Results: Eleven themes were identified across systems, personal/professional, and interpersonal domains. Barriers included inadequate training, organizational impediments, clinical quandaries and the frustrations that accompany them, issues related to share care among PCPs and specialists, antagonistic aspects of provider-patient interactions, skepticism, and time factors. Facilitators included the intellectual satisfaction of solving difficult diagnostic and management problems, the ability to develop keener communication skills, the rewards of healing and building therapeutic alliances with patients, universal protocols, and the availability of complementary and alternative medicine resources and multidisciplinary care. Conclusion:PCPs experience substantial difficulties in caring for patients with pain while acknowledging certain positive aspects. There is a need for strategies that mitigate the barriers to pain management while bolstering the positive aspects to improve care and provider satisfaction.

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Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

Lincoln

Pellico²,

Kerns³

et al. 2013

J Palliative Care Med

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“…Of the 17 RCTs, 11 focussed on SDM and included as outcome measures adherence, patient satisfaction, quality of life or well-being. Of the six excluded RCTs, in one article [19] the patient made the treatment decision, one measured clinician satisfaction [20], and four did not explicitly involve SDM of clinician and patient and/or were based on a choice between alternative treatment options [21,22,23,24]. …”

Section: Resultsmentioning

confidence: 99%

Systematic Review of the Effects of Shared Decision-Making on Patient Satisfaction, Treatment Adherence and Health Status

Joosten¹,

DeFuentes-Merillas²,

Weert

et al. 2008

Psychother Psychosom

885

670

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Background: In the last decade, the clinician-patient relationship has become more of a partnership. There is growing interest in shared decision-making (SDM) in which the clinician and patient go through all phases of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. The purpose of this review is to determine the extent, quality, and consistency of the evidence about the effectiveness of SDM. Method: This is a systematic review of randomised controlled trials (RCTs) comparing SDM interventions with non-SDM interventions. Eleven RCTs met the required criteria, and were included in this review. Results: The methodological quality of the studies included in this review was high overall. Five RCTs showed no difference between SDM and control, one RCT showed no short-term effects but showed positive longer-term effects, and five RCTs reported a positive effect of SDM on outcome measures. The two studies included of people with mental healthcare problems reported a positive effect of SDM. Conclusions: Despite the considerable interest in applying SDM clinically, little research regarding its effectiveness has been done to date. It has been argued that SDM is particularly suitable for long-term decisions, especially in the context of a chronic illness, and when the intervention contains more than one session. Our results show that under such circumstances, SDM can be an effective method of reaching a treatment agreement. Evidence for the effectiveness of SDM in the context of other types of decisions, or in general, is still inconclusive. Future studies of SDM should probably focus on long-term decisions.

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“…SDM also may make these challenging patient care decisions more rewarding for emergency physicians: primary physicians who receive SDM training report greater satisfaction with patient interactions and greater confidence in their ability to treat patients with chronic pain. 81 The working group identified the following priority questions, answers to which would help emergency physicians optimize the use of SDM for the treatment of pain among older ED patients:…”

Section: Online Decision Support Toolsmentioning

confidence: 99%

Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

Hogan

Richmond

Carpenter

et al. 2016

Academic Emergency Medicine

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Older emergency department patients have high rates of serious illness and injury, are at high risk for side effects and adverse events from treatments and diagnostic tests, and in many cases, have nuanced goals of care in which pursuing the most aggressive approach is not desired. Although some forms of shared decision making (SDM) are commonly practiced by emergency physicians caring for older adults, broader use of SDM in this setting is limited by a lack of knowledge of the types of patients and conditions for which SDM is most helpful and the approaches and tools that can best facilitate this process. We describe a research agenda to generate new knowledge to optimize the use of SDM during the emergency care of older adults.

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Brief report: Training internists in shared decision making about chronic opioid

Abstract: BACKGROUND: The use of chronic opioids for noncancer pain is an increasingly common and difficult problem in primary care.

Cited by 80 publications

References 16 publications

Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

Systematic Review of the Effects of Shared Decision-Making on Patient Satisfaction, Treatment Adherence and Health Status

Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

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