Patient and provider characteristics associated with communication about opioids: An observational study

• Published in: Patient education and counseling 2019-05, Vol.102 (5), p.888-894
• Main Authors: Shields, Cleveland G., Fuzzell, Lindsay N., Christ, Sharon L., Matthias, Marianne S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analgesics, Opioid - therapeutic use; Attitude of Health Personnel; Chronic Pain - drug therapy; Communication; Female; Health Personnel - psychology; Humans; Longitudinal Studies; Male; Middle Aged; Nursing; Opioids; Pain; Patient Participation; Patients - psychology; Physician-Patient Relations; Practice Patterns, Physicians' - statistics & numerical data; Prescription Drug Misuse - prevention & control; Provider-patient relationship
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2018.12.005

•Chronic non-cancer pain is common with over 100 million people affected.•There is little evidence that opioids are effective for long-term pain management.•Opioid prescribing for chronic pain is under increased scrutiny in the U.S.•Patient anxiety, catastrophizing, and alliance are associated with opioid talk.•Provider views on opioids, psychosocial role, and burnout linked with opioid talk. Our objective is to examine the relationship of patient and provider characteristics and communication with chronic non-cancer pain and opioid management in primary care. We conducted an observational study using audio-recorded primary care appointments (up to 3/patient) and self-reported assessments of primary care providers (PCPs) and patients. We coded visit transcripts for 1) opioid and pain management talk and 2) mental health and opioid safety talk. Eight PCPs and 30 patients had complete data for 78 clinic visits. PCPs and patients engaged in more opioid and pain management talk when patients reported greater pain catastrophizing and PCPs reported higher psychosocial orientation. PCPs and patients engaged in talk about mental health and opioid safety when patients reported greater anxiety, higher working alliance with their PCP, and when PCPs reported higher burnout. PCPs’ negative attitudes about opioids were associated with fewer discussions about mental health and opioid safety. Our results should facilitate design of interventions that improve communication and, ultimately, pain outcomes for patients. Clinicians can use our results to increase patient engagement in discussions about opioid use and pain management or mental health and safety discussions.