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The practitioner proposes a treatment change and the patient declines: what to do next?

Falzer PR, Leventhal HL, Peters E, Fried TR, Kerns R, Michalski M, Fraenkel L. The practitioner proposes a treatment change and the patient declines: what to do next? Pain practice : the official journal of World Institute of Pain. 2013 Mar 1; 13(3):215-26.

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OBJECTIVE: This study describes how pain practitioners can elicit the beliefs that are responsible for patients' judgments against considering a treatment change and activate collaborative decision making. METHODS: Beliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about the significance of pain on the patient's life. The items were aggregated into 4 decision models that predict which patients are actually considering a change in their current treatment. RESULTS: While only 34% of study participants were considering a treatment change overall, the percentage ranged from 20 to 70, depending on their ratings about current consequences of pain, emotional influence, and long-term impact. Generalized linear model analysis confirmed that a simple additive model of these 3 beliefs is the best predictor. CONCLUSION: Initial opposition to a treatment change is a conditional judgment and subject to change as specific beliefs become incompatible with patients' current conditions. These beliefs can be elicited through dialog by asking 3 questions.

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