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Strategies VA Clinicians Use to Structure Difficult Conversations Regarding Opioid Prescribing
This study aimed to identify and describe clinicians’ strategies for managing prescription opioid misuse and aberrant behaviors among patients prescribed long-term opioid therapy (LTOT) for chronic pain. Interview results identified challenges faced by clinicians in navigating conversations about opioid management, stemming from patient dissatisfaction and clinician ambivalence about enacting guideline-recommended changes. To manage difficult conversations, clinicians shared “verbal heuristics” – essentially a pre-packaged response or conversational short-cut – to more quickly and efficiently guide and defuse challenging, emotional conversations. Four varieties of heuristics were identified and include: safety (i.e., “I don’t feel comfortable prescribing for you anymore because you’re using in a way that’s unsafe.”); setting expectations (i.e., “no early refills even for legitimate reasons”); following orders (i.e., “we’re following the rules…and have no choice”), and standardization (i.e., “I do this for all my patients.”).
Date: July 1, 2019
JGIM Supplement Highlights VA’s Partnered Research
In this JGIM Supplement, 12 articles describe partnered research at various stages – from conceptualizing partnered research to examples of findings borne from bi-directional collaborations with investigators and leaders from clinical operations. These articles cover a wide range of topics highly relevant to VA policy and practice, including performance measure implementation on provider motivation, opioid management, suicide prevention, homelessness, medical home models, and communication of adverse events.
