The Practitioner Proposes a Treatment Change and the Patient Declines: What to do next?

• Published in: Pain practice 2013-03, Vol.13 (3), p.215-226
• Main Authors: Falzer, Paul R., Leventhal, Howard L., Peters, Ellen, Fried, Terri R., Kerns, Robert, Michalski, Marion, Fraenkel, Liana
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; chronic illness; Chronic Pain - therapy; Decision Making; Dissent and Disputes; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; naturalistic decision making; pain; Pain - psychology; pain management; patient perception of illness; patient-centered care; patient-centered communication; Professional-Patient Relations; shared decision making; Young Adult
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/j.1533-2500.2012.00573.x

Objective:  This study describes how pain practitioners can elicit the beliefs that are responsible for patients’ judgments against considering a treatment change and activate collaborative decision making. Methods:  Beliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about the significance of pain on the patient’s life. The items were aggregated into 4 decision models that predict which patients are actually considering a change in their current treatment. Results: While only 34% of study participants were considering a treatment change overall, the percentage ranged from 20 to 70, depending on their ratings about current consequences of pain, emotional influence, and long‐term impact. Generalized linear model analysis confirmed that a simple additive model of these 3 beliefs is the best predictor. Conclusion:  Initial opposition to a treatment change is a conditional judgment and subject to change as specific beliefs become incompatible with patients’ current conditions. These beliefs can be elicited through dialog by asking 3 questions.