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

Shared decision-making (SDM) is a widely-advocated practice that has been linked to improved patient adherence, satisfaction, and clinical outcomes. SDM is a process in which patients and providers share information, express opinions, and build consensus toward a treatment decision. Chronic pain and...

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Bibliographic Details
Published in:Health communication 2020-08, Vol.35 (10), p.1239-1247
Main Authors: Matthias, Marianne S., Talib, Tasneem L., Huffman, Monica A.
Format: Article
Language:English
Subjects:
Chronic pain
Chronic Pain - drug therapy
Clinical decision making
Clinical outcomes
Decision Making
Decision Making, Shared
Group decision making
Health care
Health Personnel
Humans
Medical personnel
Narcotics
Opioid Epidemic
Opioids
Pain
Patient Participation
Patient satisfaction
Patients
Primary care
Qualitative research
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Summary:Shared decision-making (SDM) is a widely-advocated practice that has been linked to improved patient adherence, satisfaction, and clinical outcomes. SDM is a process in which patients and providers share information, express opinions, and build consensus toward a treatment decision. Chronic pain and its treatment present unique challenges for SDM, especially in the current environment in which opioids are viewed as harmful and a national opioid crisis has been declared. The purpose of this qualitative study is to understand treatment decision-making with patients taking opioids for chronic pain. Ninety-five clinic visits and 31 interviews with patients and primary care providers (PCPs) were analyzed using the constant comparison method. Results revealed that 1) PCPs desire patient participation in treatment decisions, but with caveats where opioids are concerned; 2) Disagreements about opioids, including perceptions of lack of listening, presented challenges to SDM; and 3) PCPs described engaging in persuasion or negotiation to convince patients to try alternatives to opioids, or appeasing patients requesting opioids with very small amounts in an effort to maintain the patient-provider relationship. Results are discussed through the lens of Charles, Gafni, and Whelan's SDM model, and implications of the role of the patient-provider relationship in SDM and chronic pain treatment are discussed.
ISSN:1041-0236
1532-7027
DOI:10.1080/10410236.2019.1625000