Implementing Treat-to-Target Practices for Chronic Pain Through Shared Decision Making: Requisites, Prospects, and Challenges

Pain Practice ◽  
2016 ◽  
Vol 17 (2) ◽  
pp. 214-228 ◽  
Author(s):  
Paul R. Falzer
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Shared Decision Making ◽  
Treat To Target ◽  
Shared Decision

Preferences for shared decision making in chronic pain patients compared with patients during a premedication visit

2006 ◽  
Vol 50 (8) ◽  
pp. 1019-1026 ◽  
Author(s):  
C. D. Spies ◽  
C. M. Schulz ◽  
E. Weiß-Gerlach ◽  
B. Neuner ◽  
T. Neumann ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Managing Chronic Pain in an Opioid Crisis: What Is the Role of Shared Decision-Making?

2019 ◽  
Vol 35 (10) ◽  
pp. 1239-1247 ◽  
Author(s):  
Marianne S. Matthias ◽  
Tasneem L. Talib ◽  
Monica A. Huffman
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Opioid Crisis

Medical cannabis and cannabinoids for chronic pain: Summary of a Rapid Recommendation

2021 ◽  
Author(s):  
Jason W. Busse ◽  
James MacKillop
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Pain Relief ◽  
Sleep Quality ◽  
Shared Decision Making ◽  
Physical Functioning ◽  
Shared Decision ◽  
Medical Cannabis ◽  
Recent Guideline

LAY SUMMARY Medical cannabis is increasingly used by Canadian Veterans to manage chronic pain; however, the benefits and harms are uncertain. This commentary summarizes a recent guideline that found small to very small benefits of medical cannabis for pain relief, physical functioning and sleep quality, and evidence for a small to very small increase in several transient harms. The close balance between benefits and harms supports shared decision-making with Veterans living with chronic pain to ensure the decision whether to pursue a trial of medical cannabis is consistent with their values and preferences.

Discussions between patients with chronic pain and their primary care provider about opioids and pain relief during routine clinic encounters

2019 ◽  
Vol 15 (2) ◽  
pp. 137-146
Author(s):  
Mayra Massey, MMFT ◽  
Carissa Carissa van den Berk Clark, PhD, MSW ◽  
Jocelyn Fowler, MMFT ◽  
Jeffrey F. Scherrer, PhD
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Chronic Pain ◽  
Pain Relief ◽  
Shared Decision Making ◽  
Care Provider ◽  
Primary Care Provider ◽  
Shared Decision ◽  
Difficult Conversations ◽  
Noncancer Pain

Objective: Existing studies indicate low levels of trust and shared decision making exist in the process of prescribing opioids for noncancer pain. Patient-provider communication has not been compared between patients receiving non-opioid pain medication, and those receiving opioids. This pilot study evaluated communication about pain management between patients with noncancer pain and their provider.Design: Patient encounters with a primary care provider (PCP) were audiorecorded, followed by a short patient questionnaire to measure physician trust, depression, and anxiety.Setting: Data were collected (October 2016-May 2017) at a primary care clinic in Saint Louis, MO.Patients: Patients with noncancer chronic pain, receiving a nonsteroidal anti-inflammatory drug (NSAID) or an opioid with and without an NSAID.Methods: Medical conversation analysis guided data interpretation of codes and themes.Results: Themes were framed around stages of the routine PCP encounter (ie, opening, presenting complaint, examination, diagnosis, treatment, and closing). Themes within these stages included: managing stability (opening stage), fixation with pain (presenting complaint), changing the subject (examination stage), difficult conversations (diagnosis stage), patients chose protest or acceptance (treatment), and taking what you can get (closing).Conclusions: Much of the treatment of chronic pain, as a result of opioid prescriptions, revolves around negotiations about whether to use opioids or not. Patient education is required to disseminate realistic expectations regarding pain relief and risks of long-term opioid use. This may reduce patients’ focus on pain severity and difficult conversations and increase shared decision making.

scholarly journals Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis

2017 ◽  
Vol 77 (5) ◽  
pp. 678-683 ◽  
Author(s):  
Liana Fraenkel ◽  
W Benjamin Nowell ◽  
George Michel ◽  
Carole Wiedmeyer
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Side Effects ◽  
Shared Decision Making ◽  
Latent Class ◽  
Information Criteria ◽  
Janus Kinase ◽  
Treat To Target ◽  
Treatment Preferences ◽  
Shared Decision

ObjectiveImplementing treat-to-target (TTT) strategies requires that patients with rheumatoid arthritis (RA) and their rheumatologists decide on how best to escalate care when indicated. The objective of this study was to develop preference phenotypes to facilitate shared decision-making at the point of care for patients failing methotrexate monotherapy.MethodsWe developed a conjoint analysis survey to measure the preferences of patient with RA for triple therapy, biologics and Janus kinase (JAK) inhibitors. The survey included seven attributes: administration, onset, bothersome side effects, serious infection, very rare side effects, amount of information and cost. Each choice set (n=12) included three hypothetical profiles. Preference phenotypes were identified by applying latent class analysis to the conjoint data.Results1273 participants completed the survey. A five-group solution was chosen based on progressively lower values of the Akaike and Bayesian information criteria. Members of the largest group (group 3: 38.4%) were most strongly impacted by the cost of the medication. The next largest group (group 1: 25.8%) was most strongly influenced by the risk of bothersome side effects. Members of group 2 (11.2%) were also risk averse, but were most concerned with the risk of very rare side effects. Group 4 (6.6%) strongly preferred oral over parenteral medications. Members of group 5 (18.0%) were most strongly and equally influenced by onset of action and the risk of serious infections.ConclusionsTreatment preferences of patients with RA can be measured and represented by distinct phenotypes. Our results underscore the variability in patients’ values and the importance of using a shared decision-making approach to implement TTT.

scholarly journals Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study

10.2196/15158 ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. e15158
Author(s):  
Sonali Desai ◽  
Emma Stevens ◽  
Srinivas Emani ◽  
Peter Meyers ◽  
Maura Iversen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Outcome Measurement ◽  
Advisory Council ◽  
Treat To Target ◽  
Shared Decision ◽  
Office Visits ◽  
Patient Reported ◽  
Informal Feedback

Background Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. Objective The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. Methods Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. Results From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. Conclusions We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits.

scholarly journals Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study (Preprint)

2019 ◽  
Author(s):  
Sonali Desai ◽  
Emma Stevens ◽  
Srinivas Emani ◽  
Peter Meyers ◽  
Maura Iversen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Outcome Measurement ◽  
Advisory Council ◽  
Treat To Target ◽  
Shared Decision ◽  
Office Visits ◽  
Patient Reported ◽  
Informal Feedback

BACKGROUND Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. OBJECTIVE The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. METHODS Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. RESULTS From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. CONCLUSIONS We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits.

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