Managing Chronic Pain in an Opioid Crisis

What Is the Role of Shared Decision-Making?

Marianne Matthias, Tasneem L. Talib, Monica A. Huffman

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalHealth Communication
DOIs
StatePublished - Jan 1 2019

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Chronic Pain
Opioid Analgesics
pain
Decision Making
Decision making
decision making
Primary Health Care
Persuasive Communication
Therapeutics
Patient Participation
Negotiating
persuasion
Patient Compliance
Ambulatory Care
Patient Satisfaction
Lenses
Consensus
Patient Care
Interviews
participation

ASJC Scopus subject areas

  • Health(social science)
  • Communication

Cite this

Managing Chronic Pain in an Opioid Crisis : What Is the Role of Shared Decision-Making? / Matthias, Marianne; Talib, Tasneem L.; Huffman, Monica A.

In: Health Communication, 01.01.2019.

Research output: Contribution to journalArticle

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