beyond pain & meds: paired interviews of chronic pain patients on chronic opioid therapy (cot)...
Post on 19-Dec-2015
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Beyond pain & meds:
Paired interviews of chronic pain patients on chronic opioid therapy (COT) and their
physicians
Angela Yang, AMSII
How do long-term narcotics for chronic pain patients affect the doctor-patient relationship?
Collect narratives: Interview patients and physicians pairs
Analyze (ongoing) : identify themes, patterns, areas of convergence and mismatch
Identify/explore barriers to good communication and compassionate care (ongoing)
Brainstorm: How can the doctor be a more effective communicator and advocate for chronic pain patients on
COT? How do we bridge these gaps? What resources need to be developed for both patients and physicians ?
Interventions/solutions
Overview
How? Patients recruited through their physicians at the Family Care Center (FCC) of Memorial Hospital Where? 11 home visits, 10 at FCCWho?
21 chronic non malignant pain patients 16 physicians (of all levels of
training)What?
The In-depth Interview:I.PainII.Pain medsIII. Relationship with Doctor
Questionnaires : SF- 12, Graded Chronic Pain Scale 2.0, Prescribed Opioid Difficulties Scale, and a pictorial depiction of pain.
Collecting narratives
Patient Demographics
Age 24-62
Sex
Male 8
Female 13
Employment/disability
SSID 15
Employed 4
Unemployed 2
Marital Status
Single 11
Married 3
Divorced 6
Widowed 1
Total 21
Initial results
Patients:•Suffering from chronic pain•Role of opioid therapy for pain relief •Reliance on physicians for pain management
Physicians •Many challenges of treating chronic pain patients on COT
• Subjectivity of pain • Problems such as
diversion and dishonesty•Lack of effective therapies for pain•Concerns of harming patients by enabling an addiction
***Interviews are being examined for important themes, patterns, and major areas of convergence, and divergence/mismatch in the following groups: patients, physicians, and patient-physician pairs.
Pain confines both patients and physicians immeasurably Patients and physicians share a strong desire to improve
patient functionality and to find pain relief but long-term goals and outcomes are often unclear or unaddressed
Divergent patterns on the consequences, utility, and goals of COT underlie its impact on the doctor-patient relationship.
My current focus: the dialogue and tensions that derive from pain meds and perceptions about addiction
Unmet goals/weaknesses of the project thus far
I’m learning that …
What’s to come: ideas for healing interactions
• Medical education: students visiting chronic pain patients
• Potential interventions: chronic pain patient support groups module for physicians handout for chronic pain patients on
COT chronic pain patient advocate/counselor
• Art/prose/poetry pieces that give both patients and doctors a voice
Much gratitude to:
•Jeffrey Borkan, MD, PhD, Department of Family Medicine, AMS•Irene Reis, Administrative Assistant, Dept. of Family Medicine•Dr. Schraeder, Physician as Communicator SC• Memorial Hospital FCC: residents, attendings, & staff• Patients• Friends- Green Tea analysis team• And RI AHEC for support to make this research journey possible!