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CDA 10-034 – HSR&D Study

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CDA 10-034
Identifying Strategies to Improve Communication in Chronic Pain Care
Marianne Sassi Matthias PhD MS BA
Richard L. Roudebush VA Medical Center, Indianapolis, IN
Indianapolis, IN
Funding Period: March 2011 - February 2016

BACKGROUND/RATIONALE:
Communication between patients with chronic pain and primary care providers are frequently described as difficult, often marked by discord and mutual distrust. Such relational difficulties adversely affect both patients and providers and is particularly problematic since productive communication has been linked to patient satisfaction, adherence, and in some cases, clinical outcomes. Communication in chronic pain care is particularly critical since reliable pain assessment is heavily dependent on a patient's self-report, and research indicates that physicians are often poor judges of patients' pain levels. Productive communication is even more important when opioids are prescribed and trust between patient and provider becomes paramount.

OBJECTIVE(S):
The goal of this research is to gain a deeper understanding of pain management communication, identify strengths and weaknesses, and pinpoint areas of improvement for an intervention to improve communication and ultimately, pain management, for patients with chronic pain. The specific aims are as follows:
Aim 1: Identify strengths and weaknesses of communication between veterans with chronic pain and their providers in VA primary care visits, using the Four Habits Coding Scheme.
Aim 2: Develop and test a communication intervention to improve PCPs' communication skills in chronic pain care.
Aim 3: Develop and test a communication intervention to improve veterans' communication skills in chronic pain care.

METHODS:
Aim 1 is aimed at understanding and characterizing pain management communication. Toward this end, patients (n=40) with chronic musculoskeletal pain and their providers were recruited from VA primary care clinics. The patients' regularly scheduled clinic visits were recorded, and patients were interviewed and administered questionnaires measuring pain and depression. Interview and clinic data are being subjected to qualitative thematic analysis. In addition, clinic data will be coded using the Four Habits Coding Scheme and a shared decision making coding scheme. Results of the Four Habits and shared decision analyses will be correlated with patients' pain and depression levels. These analyses will be used to inform the development of an intervention to improve pain management communication for patients with chronic pain (Aims 2 and 3).

FINDINGS/RESULTS:
Not yet available.

IMPACT:
As the Chronic Care Model demonstrates, productive interactions between patients and providers is critical to effective self-management. In addition, patients need support in their self-management activities; other veterans have the potential to be an important and effective means of support. It is our goal to facilitate self-management by optimizing communication about pain care, both in the clinic and among other veterans with chronic pain. I fully anticipate that if the peer-support IIR is successful, our next step will be implementing peer support into clinical practice in a follow-up project.

PUBLICATIONS:

Journal Articles

  1. Bravata DM, McClain V, Austin C, Ferguson J, Burrus N, Miech EJ, Matthias MS, Chumbler N, Ofner S, Foresman B, Sico J, Vaz Fragoso CA, Williams LS, Agarwal R, Concato J, Klar Yaggi H. Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy. Sleep & Breathing = Schlaf & Atmung. 2017 Sep 1; 21(3):713-725.
  2. Matthias MS, Fukui S, Salyers MP. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits? Administration and policy in mental health. 2017 Jan 1; 44(1):133-140.
  3. Bauer SM, McGuire AB, Kukla M, McGuire S, Bair MJ, Matthias MS. Veterans' pain management goals: Changes during the course of a peer-led pain self-management program. Patient education and counseling. 2016 Dec 1; 99(12):2080-2086.
  4. Matthias MS, Kukla M, McGuire AB, Bair MJ. How Do Patients with Chronic Pain Benefit from a Peer-Supported Pain Self-Management Intervention? A Qualitative Investigation. Pain medicine (Malden, Mass.). 2016 Dec 1; 17(12):2247-2255.
  5. Matthias MS, Kukla M, McGuire AB, Damush TM, Gill N, Bair MJ. Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain. The Clinical Journal of Pain. 2016 Jun 1; 32(6):534-40.
  6. Eliacin J, Rollins AL, Burgess DJ, Salyers MP, Matthias MS. Patient activation and visit preparation in African American veterans receiving mental health care. Cultural Diversity & Ethnic Minority Psychology. 2016 Oct 1; 22(4):580-587.
  7. Stahl SM, Yaggi HK, Taylor S, Qin L, Ivan CS, Austin C, Ferguson J, Radulescu R, Tobias L, Sico J, Vaz Fragoso CA, Williams LS, Lampert R, Miech EJ, Matthias MS, Kapoor J, Bravata DM. Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke. Sleep Medicine. 2015 Oct 1; 16(10):1198-203.
  8. Eliacin J, Salyers MP, Kukla M, Matthias MS. Patients' understanding of shared decision making in a mental health setting. Qualitative Health Research. 2015 May 1; 25(5):668-78.
  9. Eliacin J, Salyers MP, Kukla M, Matthias MS. Factors influencing patients' preferences and perceived involvement in shared decision-making in mental health care. Journal of mental health (Abingdon, England). 2015 Feb 1; 24(1):24-8.
  10. Fukui S, Matthias MS, Salyers MP. Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions. Administration and policy in mental health. 2015 Jan 1; 42(1):40-6.
  11. Matthias MS, Fukui S, Kukla M, Eliacin J, Bonfils KA, Firmin RL, Oles SK, Adams EL, Collins LA, Salyers MP. Consumer and relationship factors associated with shared decision making in mental health consultations. Psychiatric services (Washington, D.C.). 2014 Dec 1; 65(12):1488-91.
  12. Krebs EE, Bergman AA, Coffing JM, Campbell SR, Frankel RM, Matthias MS. Barriers to guideline-concordant opioid management in primary care--a qualitative study. The journal of pain : official journal of the American Pain Society. 2014 Nov 1; 15(11):1148-55.
  13. Matthias MS, McGuire AB, Kukla M, Daggy J, Myers LJ, Bair MJ. A brief peer support intervention for veterans with chronic musculoskeletal pain: a pilot study of feasibility and effectiveness. Pain medicine (Malden, Mass.). 2015 Jan 1; 16(1):81-7.
  14. Hirsh AT, Hollingshead NA, Bair MJ, Matthias MS, Kroenke K. Preferences, experience, and attitudes in the management of chronic pain and depression: a comparison of physicians and medical students. The Clinical Journal of Pain. 2014 Sep 1; 30(9):766-74.
  15. Matthias MS, Krebs EE, Bergman AA, Coffing JM, Bair MJ. Communicating about opioids for chronic pain: a qualitative study of patient attributions and the influence of the patient-physician relationship. European journal of pain (London, England). 2014 Jul 1; 18(6):835-43.
  16. Fukui S, Salyers MP, Matthias MS, Collins L, Thompson J, Coffman M, Torrey WC. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community mental health journal. 2014 May 1; 50(4):375-82.
  17. Hirsh AT, Hollingshead NA, Matthias MS, Bair MJ, Kroenke K. The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions. The journal of pain : official journal of the American Pain Society. 2014 May 1; 15(5):551-9.
  18. Matthias MS, Chumbler NR, Bravata DM, Yaggi HK, Ferguson J, Austin C, McClain V, Dallas MI, Couch CD, Burrus N, Miech EJ. Challenges and motivating factors related to positive airway pressure therapy for post-TIA and stroke patients. Behavioral sleep medicine. 2014 Mar 4; 12(2):143-57.
  19. Saleem JJ, Flanagan ME, Russ AL, McMullen CK, Elli L, Russell SA, Bennett KJ, Matthias MS, Rehman SU, Schwartz MD, Frankel RM. You and me and the computer makes three: variations in exam room use of the electronic health record. Journal of the American Medical Informatics Association : JAMIA. 2014 Feb 1; 21(e1):e147-51.
  20. Matthias MS, Miech EJ, Myers LJ, Sargent C, Bair MJ. A qualitative study of chronic pain in Operation Enduring Freedom/Operation Iraqi Freedom veterans: "A burden on my soul". Military medicine. 2014 Jan 1; 179(1):26-30.
  21. Bergman AA, Matthias MS, Coffing JM, Krebs EE. Contrasting tensions between patients and PCPs in chronic pain management: a qualitative study. Pain medicine (Malden, Mass.). 2013 Nov 1; 14(11):1689-97.
  22. Hirsh AT, Hollingshead NA, Bair MJ, Matthias MS, Wu J, Kroenke K. The influence of patient's sex, race and depression on clinician pain treatment decisions. European journal of pain (London, England). 2013 Nov 1; 17(10):1569-79.
  23. Matthias MS, Krebs EE, Collins LA, Bergman AA, Coffing J, Bair MJ. "I'm not abusing or anything": patient-physician communication about opioid treatment in chronic pain. Patient education and counseling. 2013 Nov 1; 93(2):197-202.
  24. Frankel RM, Salyers MP, Bonfils KA, Oles SK, Matthias MS. Agenda setting in psychiatric consultations: an exploratory study. Psychiatric Rehabilitation Journal. 2013 Sep 1; 36(3):195-201.
  25. Salyers MP, Matthias MS, Sidenbender S, Green A. Patient activation in schizophrenia: insights from stories of illness and recovery. Administration and policy in mental health. 2013 Sep 1; 40(5):419-27.
  26. Matthias MS, Salyers MP, Frankel RM. Re-thinking shared decision-making: context matters. Patient education and counseling. 2013 May 1; 91(2):176-9.
  27. Matthias MS, Miech EJ, Myers LJ, Sargent C, Bair MJ. An expanded view of self-management: patients' perceptions of education and support in an intervention for chronic musculoskeletal pain. Pain medicine (Malden, Mass.). 2012 Aug 1; 13(8):1018-28.
  28. Salyers MP, Matthias MS, Fukui S, Holter MC, Collins L, Rose N, Thompson JB, Coffman MA, Torrey WC. A coding system to measure elements of shared decision making during psychiatric visits. Psychiatric services (Washington, D.C.). 2012 Aug 1; 63(8):779-84.
  29. Matthias MS, Miech EJ, Myers LJ, Sargent C, Bair MJ. "There's more to this pain than just pain": how patients' understanding of pain evolved during a randomized controlled trial for chronic pain. The journal of pain : official journal of the American Pain Society. 2012 Jun 1; 13(6):571-8.
  30. Matthias MS, Salyers MP, Rollins AL, Frankel RM. Decision making in recovery-oriented mental health care. Psychiatric Rehabilitation Journal. 2012 May 17; 35(4):305-14.
  31. Bergman AB, Coffing J, Matthias MS, Krebs EE. Managing chronic pain with opioid medications: Patients voices. Journal of general internal medicine. 2012 Mar 1; 27(S2):S243.
  32. Matthias MS, Miech EJ, Myers L, Sargent C, Bair MJ. "She makes me feel like I'm an All-Star": Patients' experiences with self-management education in an intervention for chronic musculoskeletal pain. Journal of general internal medicine. 2012 Mar 1; 27(S2):356.
  33. Bravata DM, Ferguson J, Miech EJ, Agarwal R, McClain V, Austin C, Struve F, Foresman B, Li X, Wang Z, Williams LS, Dallas MI, Couch CD, Sico J, Fragoso C, Matthias MS, Chumbler N, Myers J, Burrus N, Dube A, French DD, Schmid AA, Concato J, Yaggi HK. Diagnosis and Treatment of Sleep Apnea in patients' homes: the rationale and methods of the "GoToSleep" randomized-controlled trial. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2012 Feb 15; 8(1):27-35.
Journal Other

  1. Matthias MS, McGuire AB, Kukla ME, Daggy J, Myers L, Bair MJ. Effectiveness of a brief peer support intervention for veterans with chronic pain. [Abstract]. Journal of general internal medicine. 2014 Apr 16; 29(1):80.
  2. Damush TM, Daggett VS, Plue LD, Myers J, Mathias M, Robinson J, Williams LS. Stroke Clinical Champions and Quality Improvment. [Abstract]. Circulation. Cardiovascular quality and outcomes. 2012 May 1; 5(3):A172.
  3. Hirsh A, Hollingshead N, Wu J, Bair MJ, Matthias MS, Kroenke K. Provider decision making in chronic pain management: Influence of patient sex, race, and depression. [Abstract]. The journal of pain : official journal of the American Pain Society. 2012 Apr 1; 13(4):S106.
  4. Bair MJ, Matthias MS. Response to letter by Dr. Sciascia. [Letter to the Editor]. Pain medicine (Malden, Mass.). 2011 Dec 1; 12(1):1693.
  5. Campbell SR, Matthias MS, Bergman AB, Krebs E. "I feel like I’m not a doctor”: Physicians’ perceptions of opioid management. [Editorial]. Journal of general internal medicine. 2011 Jul 1; 26(S-1):264-5.
  6. Miech EJ, Sternke EA, Myers L, Bair MJ, Matthias MS. "There’s more to this pain than just pain": How patients understand the management of chronic pain. [Abstract]. Journal of general internal medicine. 2011 Jun 1; 26(S1):S73.
Center Products

  1. Matthias MS. Chronic diseases. In: Encyclopedia of Health Communication. Sage Publications. 178-183 p. 2014 May 7.
  2. Matthias MS. Childbirth. In: Encyclopedia of Health Communication. Sage Publications. 167-170 p. 2014 May 7.
Conference Presentations

  1. Matthias MS, Kukla ME, McGuire AB, Bair MJ. Facilitators and barriers to peer support for chronic pain self-management in Veterans. Poster session presented at: American Pain Society Annual Meeting; 2015 May 13; Palm Springs, CA.
  2. Fukui S, Salyers MP, Matthias MS. Shared decisionmaking (SDM) for people with serious mental illness. Paper presented at: Society for Social Work and Research Annual Conference; 2014 Jan 15; San Antonio, TX.
  3. Bonfils KA, Frankel RM, Salyers MP, Oles S, Matthias MS. Agenda setting in psychiatric consultations: An exploratory study. Poster session presented at: Midwestern Psychological Association Annual Meeting; 2013 May 2; Chicago, IL.
  4. Schmid AA, Yaggi HK, Burrus N, McClain V, Austin CC, Ferguson J, Fragoso C, Sico JJ, Miech EJ, Matthias MS, Williams LS, Bravata DM. The circumstances and consequences of post-stroke falls. Poster session presented at: American Heart Association / American Stroke Association International Stroke Conference; 2013 Feb 6; Honolulu, HI.
  5. Krebs EE, Matthias MS, Bergman AB, Coffing J, Campbell S, Frankel RM. Perceptions of opioid monitoring in VA primary care: "We just home they don't call back.". Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 14; National Harbor, MD.
  6. Hirsh AT, Hollingshead NA, Wu J, Bair MJ, Matthias MS, Kroenke K. Provider decision making in chronic pain management: Influence of patient sex, race, and depression. Poster session presented at: American Pain Society Annual Meeting; 2012 May 16; Honolulu, HI.
  7. Matthias MS, Miech EJ, Myers L, Sargent C, Bair MJ. "She Makes Me Feel Like an All-Star": Patients’ Experiences with Self-Management Education in an Intervention for Chronic Musculoskeletal Pain. Paper presented at: Society of General Internal Medicine Annual Meeting; 2012 May 11; Orlando, FL.
  8. Damush TM, Daggett VS, Plue LD, Myers J, Matthias MS, Robinson J, Williams LS. Stroke Clinical Champions and Quality Improvement. Poster session presented at: Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Annual Scientific Forum; 2012 May 9; Atlanta, GA.
  9. Bergman AB, Matthias MS, Coffing JM, Krebs EE. Managing chronic pain with opioid medications: Patient voices. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2012 May 1; Orlando, FL.
  10. Matthias MS, Bergman AB, Bair MJ, Coffing JM, Collins LA, Krebs EE. "I'm not abusing or anything": Patient provider communication about opioid treatment. Paper presented at: International Conference on Communication in Healthcare; 2011 Oct 17; Chicago, IL.
  11. Campbell SR, Matthias MS, Bergman AB, Krebs E. "I feel like I’m not a doctor”: Physicians’ perceptions of opioid management. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 10; Phoenix, AZ.
  12. Matthias MS, Miech EJ, Sternke EA, Myers L, Bair MJ, Sargent C. "There’s more to this pain than just pain": How patients understand the management of chronic pain. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 4; Phoenix, AZ.


DRA: Musculoskeletal Disorders
DRE: Technology Development and Assessment
Keywords: none
MeSH Terms: none

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