PS 4-9 COMPARING PATIENT AND PROVIDER IDENTIFIED STRATEGIES TO IMPROVE COMMUNICATION ABOUT CHRONIC PAIN: WHAT'S SHARED DECISION MAKING GOT TO DO WITH IT?

Wednesday, October 26, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 4-9

Nananda F. Col, MD, MPH, MPP, FACP1, Stephen Hull, MD2, Vicky Springmann, MSc3, Mark Braun, MD, FACP4, Noah Nesin, MD5, Penney Cowan6, Samantha Shephard7, Lisa Marrache, MD8, Noel Geneva, MA, PA-C9, Rich Entel, MD10 and Edward Bilsky, PhD7, (1)Shared Decision Making Resources, Georgetown, ME, (2)Mercy Pain Center, Mercy Hospital, Portland, ME, (3)Tononto, ON, Canada, (4)Scarborough, ME, (5)Penobscot Community Health Care, Lincoln, ME, (6)American Chronic Pain Association, Rocklin, CA, (7)University of New England, Biddeford, ME, (8)VA Maine Healthcare System, Augusta, ME, (9)Portland Internal Medicine, Mercy Hospital/Eastern Maine Health Systems, Portland, ME, (10)Grace Street Services, Portland, ME
Purpose: As the U.S.  healthcare system transitions from a biologic, opioid-prescribing focus to a more comprehensive biopsychosocial and patient-engaged approach for managing chronic pain, new tools are needed to facilitate communication about the patient’s care plan.  Shared decision making (SDM) typically informs the design of such tools, but different SDM models have been described. We aimed to identify strategies to improve the clinical dialogue surrounding chronic pain, within a SDM framework.

Method:

Structured focus groups using Nominal Group Technique were conducted among patients with chronic pain and experienced health care providers (HCPs). Three groups of 5-9 participants responded succinctly to one question: “What would make it easier to communicate with your doctor [patients] about chronic pain and how to manage it?” Responses were shared within the group, consolidated, and ranked by participants (top 9). Scores were summed to develop a prioritized list.

Result:

Analyses included 14 patients from across the U.S. (67% female, 87% white) and 7 HCPs (MD/DO/PA) from Maine. Patients generated 41 unique strategies, HCPs generated 35. The most important patient-generated strategies were: “clinician takes me seriously and respects my input”, “being involved as an integral part of my treatment team”, “clinician is knowledgeable about my condition”, “clinician takes time needed”, “be told about all options”, and “clinician does not pressure me”.  Many patient strategies addressed compassion, trust, encouragement, helplessness, and stigma. The most important HCP strategy was “knowledge of past work-up”, followed by “timeline of the pain”, “hearing how patients believe their pain has impacted their lives”, and “listen to their story”. Strategies prioritized by both patients and HCPs were: “enough time”, “better knowledge about the patient’s condition”, and “improved collaboration among HCPs”. Both groups prioritized knowledge about their condition over knowledge about treatment options.

Conclusion: Patients focused on transforming HCP perceptions, behaviors, and attitudes, whereas HCPs focused on gathering biologic or psychosocial information about their patients. HCPs prioritized collecting biologic over psychosocial data, which might reflect a higher value attached to biologic data, a desire to simplify data collection to enable more time to discuss psychosocial issues with patients, or both. Communication tools may be able to indirectly promote SDM by helping HCPs simplify time-consuming data-collection tasks. Our findings support SDM models that prioritize sharing information about the patient’s condition.

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See more of: 38th Annual North American Meeting of the Society for Medical Decision Making