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Gerwing J, White AEC, Henry SG. Communicative Practices Clinicians Use to Correct Patient Misconceptions in Primary Care Visits. HEALTH COMMUNICATION 2023:1-16. [PMID: 38111218 PMCID: PMC11182885 DOI: 10.1080/10410236.2023.2283658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
To investigate how clinicians correct patient misconceptions, we analyzed 23 video recordings of primary care visits. Analysis focused on operationalizing, identifying, and characterizing clinician corrections, integrating two inductive approaches: microanalysis of clinical interaction and conversation analysis. According to our definition, patient misconception-clinician correction episodes met three essential criteria: (1) the clinician refuted something the patient had said, (2) which the patient had presented without uncertainty, and (3) which contained a proposition that was factually incorrect. We identified 59 such episodes; the patient misconceptions most commonly related to medication issues; fewer than half had foreseeable implications for patients' future actions. We identified seven clinician correction practices: Three direct practices (displaying surprise, marking disagreement, contradicting the patient) and four indirect practices (presenting the correct proposition, providing explanations, invoking an outside authority, demonstrating with evidence). We found an almost equal distribution of these direct and indirect practices.
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Affiliation(s)
- J. Gerwing
- Health Services Research Unit, Akershus University Hospital, Norway
| | - Anne E. C. White
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA
| | - Stephen G. Henry
- Department of Internal Medicine, University of California Davis, Sacramento, California, USA
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Conrad M, Steffensmeier KS, Van Tiem J, Obrecht A, Mares J, Mosher HJ, Weg MWV, Sibenaller Z, Stout L, Patel P, Hadlandsmyth K. Military Veterans' Perspectives on Postoperative Opioid Use: A Secondary Analysis of Qualitative Data. J Perianesth Nurs 2023; 38:483-487. [PMID: 36635123 DOI: 10.1016/j.jopan.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE This qualitative analysis of interviews with surgical patients who received a brief perioperative psychological intervention, in conjunction with standard medical perioperative care, elucidates patient perspectives on the use of pain self-management skills in relation to postoperative analgesics. DESIGN This study is a secondary analysis of qualitative data from a randomized controlled trial. METHODS Participants (N = 21) were rural-dwelling United States Military Veterans from a mixed surgical sample who were randomized to receive a manual-based, telephone-based Perioperative Pain Self-management intervention consisting of a total of four pre- and postoperative contacts. Semi-structured qualitative interviews elicited participant feedback on the cognitive-behavioral intervention. Data was analyzed by two qualitative experts using MAXQDA software. Key word analyses focused on mention of analgesics in interviews. FINDINGS Interviews revealed a dominant theme of ambivalence towards postoperative use of opioids. An additional theme concerned the varied ways acquiring pain self-management skills impacted postoperative opioid (and non-opioid analgesic) consumption. Participants reported that employment of pain self-management strategies reduced reliance on pharmacology for pain relief, prolonged the time between doses, took the "edge off" pain, and increased pain management self-efficacy. CONCLUSIONS Perioperative patient education may benefit from inclusion of teaching non-pharmacologic pain self-management skills and collaborative planning with patients regarding how to use these skills in conjunction with opioid and non-opioid analgesics. Perianesthesia nurses may be in a critical position to provide interdisciplinary postoperative patient education that may optimize postoperative pain management while minimizing risks associated with prolonged opioid use.
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Affiliation(s)
- Mandy Conrad
- Center for Integrated Healthcare, Buffalo, NY; Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA.
| | - Kenda Stewart Steffensmeier
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA
| | - Jennifer Van Tiem
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA
| | - Ashlie Obrecht
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA
| | - Jasmine Mares
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
| | - Hilary J Mosher
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa, Carver College of Medicine, Department of Internal Medicine, Iowa City, IA
| | - Mark W Vander Weg
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa, College of Public Health, Department of Community and Behavioral Health, Iowa City, IA
| | - Zita Sibenaller
- University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
| | - Lori Stout
- University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
| | | | - Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, IA
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Hood-Medland EA, White AEC, Kravitz RL, Henry SG. Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain. BMC FAMILY PRACTICE 2021; 22:4. [PMID: 33397299 PMCID: PMC7780618 DOI: 10.1186/s12875-020-01317-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
Background Agenda setting is associated with more efficient care and better patient experience. This study develops a taxonomy of visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience. Methods This observational study analyzed 83 video recorded US primary care visits at a single academic medical center in California involving family medicine and internal medicine resident physicians (n = 49) and patients (n = 83) with chronic pain on opioids. Using conversation analysis, we developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discussed. Exploratory quantitative analyses were conducted to assess the relationship of agenda setting and visit opening styles with post-visit measures of both patient experience and physician perception of visit difficulty. Results We identified 2 visit opening styles representing agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda setting opening styles (open-ended question, patient launch, physician launch). Agenda setting was only performed in 11% of visits and was associated with fewer surprise patient topics than visits without agenda setting (mean (SD) 2.67 (1.66) versus 4.28 (3.23), p = 0.03). Conclusions In this study of patients with chronic pain, resident physicians rarely performed agenda setting, whether defined in terms of “agenda eliciting” or “agenda re-framing.” Agenda setting was associated with fewer surprise topics. Understanding the communication context and outcomes of agenda setting may inform better use of this communication tool in primary care practice.
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Affiliation(s)
- Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| | - Anne E C White
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA. .,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA.
| | - Richard L Kravitz
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| | - Stephen G Henry
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
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Matthias MS, Talib TL, Huffman MA. Managing Chronic Pain in an Opioid Crisis: What Is the Role of Shared Decision-Making? HEALTH COMMUNICATION 2020; 35:1239-1247. [PMID: 31179769 PMCID: PMC6901808 DOI: 10.1080/10410236.2019.1625000] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Marianne S Matthias
- Department of Veterans Affairs, Center for Health Information and Communication
- Department of Communication Studies, Indiana University-Purdue University
- Regenstrief Institute
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine
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Torres PJ, Henry SG, Ramanathan V. Let's talk about pain and opioids: Low pitch and creak in medical consultations. DISCOURSE STUDIES 2020; 22:174-204. [PMID: 32256188 PMCID: PMC7111341 DOI: 10.1177/1461445619893796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In recent years, the opioid crisis in the United States has sparked significant discussion on doctor-patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when describing chronic pain, narrating symptoms, and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions.
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Affiliation(s)
| | - Stephen Gresham Henry
- Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CA, USA
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Edwards PJ, Ridd MJ, Sanderson E, Barnes RK. Development of a tool for coding safety-netting behaviours in primary care: a mixed-methods study using existing UK consultation recordings. Br J Gen Pract 2019; 69:e869-e877. [PMID: 31740456 PMCID: PMC6863675 DOI: 10.3399/bjgp19x706589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Safety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours. AIM To develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations. DESIGN AND SETTING A mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations. METHOD Key components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated. RESULTS The tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (κ = 0.66). CONCLUSION The authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.
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Affiliation(s)
- Peter J Edwards
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
| | - Matthew J Ridd
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
| | - Emily Sanderson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
| | - Rebecca K Barnes
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol
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Henry SG, Matthias MS. Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review. PAIN MEDICINE 2019; 19:2154-2165. [PMID: 29401356 DOI: 10.1093/pm/pny003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research. Methods A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development. Results The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids. Conclusions Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Shields CG, Fuzzell LN, Christ SL, Matthias MS. Patient and provider characteristics associated with communication about opioids: An observational study. PATIENT EDUCATION AND COUNSELING 2019; 102:888-894. [PMID: 30552013 PMCID: PMC6491239 DOI: 10.1016/j.pec.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/16/2018] [Indexed: 05/07/2023]
Abstract
OBJECTIVE 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. METHOD 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. RESULTS 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. CONCLUSIONS Our results should facilitate design of interventions that improve communication and, ultimately, pain outcomes for patients. PRACTICE IMPLICATIONS Clinicians can use our results to increase patient engagement in discussions about opioid use and pain management or mental health and safety discussions.
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Affiliation(s)
- Cleveland G Shields
- Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA.
| | - Lindsay N Fuzzell
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Sharon L Christ
- Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA; Purdue University, Department of Statistics, West Lafayette, IN, 47906, USA
| | - Marianne S Matthias
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
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Communication about chronic pain and opioids in primary care: impact on patient and physician visit experience. Pain 2019; 159:371-379. [PMID: 29112009 DOI: 10.1097/j.pain.0000000000001098] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients and physicians report that communication about chronic pain and opioids is often challenging, but there is little empirical research on whether patient-physician communication about pain affects patient and physician visit experience. This study video recorded 86 primary care visits involving 49 physicians and 86 patients taking long-term opioids for chronic musculoskeletal pain, systematically coded all pain-related utterances during these visits using a custom-designed coding system, and administered previsit and postvisit questionnaires. Multiple regression was used to identify communication behaviors and patient characteristics associated with patients' ratings of their visit experience, physicians' ratings of visit difficulty, or both. After adjusting for covariates, 2 communication variables-patient-physician disagreement and patient requests for opioid dose increases-were each significantly associated with both worse ratings of patient experience and greater physician-reported visit difficulty. Patient desire for increased pain medicine was also significantly positively associated with both worse ratings of patient experience and greater physician-reported visit difficulty. Greater pain severity and more patient questions were each significantly associated with greater physician-reported visit difficulty, but not with patient experience. The association between patient requests for opioids and patient experience ratings was wholly driven by 2 visits involving intense conflict with patients demanding opioids. Patient-physician communication during visits is associated with patient and physician ratings of visit experience. Training programs focused on imparting communication skills that assist physicians in negotiating disagreements about pain management, including responding to patient requests for more opioids, likely have potential to improve visit experience ratings for both patients and physicians.
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Chaudhary S, Compton P. Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Subst Abus 2016; 38:95-104. [DOI: 10.1080/08897077.2016.1265038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sahil Chaudhary
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Peggy Compton
- Department of Advanced Nursing Practice, Georgetown University, Washington, DC, USA
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