TY - JOUR
T1 - Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management
AU - Nicolaidis, Christina
N1 - Funding Information:
I am most grateful to Paul Bascom, MD, who originally taught me to use the benefit-to-harm framework when managing patients with chronic nonmalignant pain. I would also like to thank Katherine Bensching, MD, Elizabeth Haney, MD, and Mary Picket, MD for their thoughtful comments on earlier versions of this manuscript. My time was funded, in part, by a career development award from the National Institute of Mental Health (K23MH073008). This article has been presented at Annual Meetings of the Society of General Internal Medicine and the American College of Physicians as well as at continuing medical education courses at Oregon Health & Science University and the Southern Oregon Regional Palliative Care Conference.
PY - 2011/6
Y1 - 2011/6
N2 - How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be nonjudgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or a judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the American Pain Society/American Academy of Pain Medicine guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This article discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic nonmalignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. Wiley Periodicals, Inc.
AB - How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be nonjudgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or a judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the American Pain Society/American Academy of Pain Medicine guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This article discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic nonmalignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. Wiley Periodicals, Inc.
KW - Chronic Non-Malignant Pain
KW - Opioid Management
KW - Patient Communication
KW - Patient-Centered Care
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U2 - 10.1111/j.1526-4637.2011.01117.x
DO - 10.1111/j.1526-4637.2011.01117.x
M3 - Review article
C2 - 21539703
AN - SCOPUS:79959279264
SN - 1526-2375
VL - 12
SP - 890
EP - 897
JO - Pain Medicine
JF - Pain Medicine
IS - 6
ER -