Cleveland G Shields1, Lindsay N Fuzzell2, Sharon L Christ3, Marianne S Matthias4. 1. Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA. Electronic address: cgshields@purdue.edu. 2. Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO USA. 3. Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA; Purdue University, Department of Statistics, West Lafayette, IN, 47906, USA. 4. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.
Abstract
OBJECTIVE: Our objective is to examine the relationship of patient and provider characteristics and communication with chronic non-cancer pain and opioid management in primary care. METHOD: We conducted an observational study using audio-recorded primary care appointments (up to 3/patient) and self-reported assessments of primary care providers (PCPs) and patients. We coded visit transcripts for 1) opioid and pain management talk and 2) mental health and opioid safety talk. RESULTS: Eight PCPs and 30 patients had complete data for 78 clinic visits. PCPs and patients engaged in more opioid and pain management talk when patients reported greater pain catastrophizing and PCPs reported higher psychosocial orientation. PCPs and patients engaged in talk about mental health and opioid safety when patients reported greater anxiety, higher working alliance with their PCP, and when PCPs reported higher burnout. PCPs' negative attitudes about opioids were associated with fewer discussions about mental health and opioid safety. CONCLUSIONS: Our results should facilitate design of interventions that improve communication and, ultimately, pain outcomes for patients. PRACTICE IMPLICATIONS: Clinicians can use our results to increase patient engagement in discussions about opioid use and pain management or mental health and safety discussions.
OBJECTIVE: Our objective is to examine the relationship of patient and provider characteristics and communication with chronic non-cancer pain and opioid management in primary care. METHOD: We conducted an observational study using audio-recorded primary care appointments (up to 3/patient) and self-reported assessments of primary care providers (PCPs) and patients. We coded visit transcripts for 1) opioid and pain management talk and 2) mental health and opioid safety talk. RESULTS: Eight PCPs and 30 patients had complete data for 78 clinic visits. PCPs and patients engaged in more opioid and pain management talk when patients reported greater pain catastrophizing and PCPs reported higher psychosocial orientation. PCPs and patients engaged in talk about mental health and opioid safety when patients reported greater anxiety, higher working alliance with their PCP, and when PCPs reported higher burnout. PCPs' negative attitudes about opioids were associated with fewer discussions about mental health and opioid safety. CONCLUSIONS: Our results should facilitate design of interventions that improve communication and, ultimately, pain outcomes for patients. PRACTICE IMPLICATIONS: Clinicians can use our results to increase patient engagement in discussions about opioid use and pain management or mental health and safety discussions.
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