Module 3: Communicating with Patients

Welcome

Communicating with Patients

Applying CDC's Guideline for Prescribing Opioids

Slide narration: Hello, and welcome to the CDC series Applying CDC's Guideline for Prescribing Opioids. In this module, we will review the CDC recommended strategies for communicating effectively with patients about pain management and opioid use. You will have the opportunity to learn the importance of communicating relevant information to your patients, how to apply motivational interviewing to encourage changes in chronic pain management and use of opioids, and how to properly address conflicts that sometimes arise.At the end of the module, you will be presented multiple choice knowledge check questions to test your mastery of the content.

CDC Guideline for Prescribing Opioids for Chronic Pain

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CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016

Narration text: You may find it useful to refer to the CDC Guideline during this module. You can access, download, and print a copy of this and other helpful documents by selecting the Resources tab at any time. Some screens include a link icon which, when selected, opens additional online resources. Let's take a closer look at the navigation features of this web-based training. As you've experienced already, the Next and Back buttons enable you to move to a new screen or back to a previous screen. If either the Next or Back button is dimmed, it is disabled, and you will need to complete an action onscreen to continue. Refer to the navigation prompt located at the bottom of the screen to help you determine how to proceed. Selecting the Menu button in the upper right corner opens a list of all the topics available in the module. A selection made from the list advances the training to that topic. Pressing the open Menu tab a second time will collapse it. There is also a set of audio controls located at the bottom of the training window. Here you can pause or play the narration, control the volume, and open the text transcript for the narration if needed. Most slides, however, will not be narrated, and this set of controls will be dimmed and disabled.

Module Objectives

After completing this module, you should be able to:

CDC Recommendations

The CDC Guideline for Prescribing Opioids for Chronic Pain stresses the importance of collaboration between doctor and patient. Here we emphasize three specific recommendations that highlight the importance of improved collaboration between providers and patients. They provide a basis for discussing with patients the risks and benefits associated with using opioids for chronic pain while working with patients to define realistic goals for function and pain relief to help them improve their quality of life.

Develop Treatment Goals

In Recommendation 2, CDC recommends clinicians and patients agree on treatment goals together. This includes encouraging a collaborative dialogue with patients to develop specific steps for managing pain while improving activity and function, and recognizing that complete elimination of pain is often not possible with or without use of opioids.

Discuss Risks and Benefits

In Recommendation 3, CDC recommends clinicians and patients consider known risks and benefits of initial and continued opioid therapy. Explain benefits as well as common and serious harms of opioid therapy with patients, and then define your collective responsibilities to mitigating risks of opioid therapy. You should also learn about your patient's preferences and values so that you may apply this knowledge to clinical decisions.

Frequently Evaluate

In Recommendation 7, CDC recommends clinicians evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dosage escalation. You should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. This includes sharing any knowledge of co-prescriptions or potentially dangerous interactions found in the prescription drug monitoring program (PDMP). If at any point the benefits do not outweigh harms of continued opioid therapy, you should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.

Research Can Inform Communication

Research findings inform how and what we communicate to our patients who are experiencing chronic pain. These findings include:

Principles of Communication with Patients Experiencing Chronic Pain

Effective strategies for working with patients with chronic pain are not learned in a single session. They must be practiced, reviewed, and applied consistently over time. Careful consideration and practice with the following three strategies will lead to improved communication with patients who are experiencing chronic pain.

Establish Trust

Establish trust and express empathy regarding the impact of pain on daily activity and function.

Consider Effect on Quality of Life

Review how current treatment is helping or hindering the patient's quality of life.

Explore Options

Explore options to get to a safer and more effective approach to managing chronic pain long-term.

Establish Trust

Trust is established through compassion and empathy, which strengthens the provider-patient relationship. Learn more by selecting a topic from the left menu.

Slow Down

Take time to listen to your patient. Show, both verbally and nonverbally, that you are genuinely interested in helping and collaborating with the patient to find a solution. Check often to ensure your patient understands what is being communicated. Educate your patient to support recommendations or clarify any misunderstandings. Take the time necessary to review and discuss treatment options and fully explain associated risks and benefits. Emphasize your concern for their safety and the desire to find safe approaches that will enhance overall quality of life, not just reduce pain temporarily.

Recognize Patient's Uniqueness

Address your patient by name and be sure to consider your patient's culture, experience, and social influences. Keep in mind that patients may interpret and communicate symptoms, illness, and treatments based on their unique cultural perspective, which may vary greatly from your clinical understanding.

Listen Reflectively

Listen intently to your patient's concerns, trying to empathize with his or her perspective. Maintain eye contact and use appropriate nonverbal cues. Relay the information back to the patient in his or her own words to confirm understanding. Allow adequate time to correct misunderstandings and answer questions.

Show Empathy

Use empathic statements, such as:

Consider your nonverbal communication, such as:

Consider Effects on Patients' Quality of Life

Change happens from within. Collaborate with each of your patients to evaluate how current therapy is impacting quality of life and to assess readiness for change.

Motivational Interviewing?

What is motivational interviewing?

Motivational interviewing:

Motivational interviewing can help encourage patients to make personal changes they already deem important for reaching a particular goal, such as regular exercise or eating a balanced diet.

Goals of Motivational Interviewing

Many patients using opioids long-term for chronic pain would like to reduce their dosage or stop using opioids altogether. They may already be well aware of the risks of long-term opioid use and in tune with the side effects that they are experiencing.

Simultaneously, they may be fearful that making any changes in their pain management will increase their pain. Willingness to try out a new approach on an "experimental" basis requires trust.

Through motivational interviewing techniques, providers and patients together consider: