title: Older people's experiences of patient-centered treatment for chronic pain: a qualitative study.
abstract: BACKGROUND
  Older adults with chronic pain who seek treatment often are in a health care environment that emphasizes patient-directed care, a change from the patriarchal model of care to which many older adults are accustomed.
  
  
  OBJECTIVE
  To explore the experiences of older adults seeking treatment for chronic pain, with respect to patient-directed care and the patient-provider relationship.
  
  
  METHODS
  In-depth interviews with 15 Caucasian older adults with chronic pain who had been evaluated at a university-based pain clinic. All interviews were audiotaped and the transcripts were analyzed using a grounded theory based approach.
  
  
  RESULTS
  Older adults with chronic pain vary in their willingness to be involved in their treatment decisions. Many frequently participate in decisions about their pain treatment by asking for or refusing specific treatments, demanding quality care, or operating outside of the patient-provider relationship to manage pain on their own. However, others prefer to let their provider make the decisions. In either case, having a mutually respectful patient-provider relationship is important to this population. Specifically, participants described the importance of "being heard" and "being understood" by providers.
  
  
  CONCLUSIONS
  As some providers switch from a patriarchal model of care toward a model of care that emphasizes patient activation and patient-centeredness, the development and cultivation of valued patient-provider relationships may change. While it is important to encourage patient involvement in treatment decisions, high-quality, patient-centered care for older adults with chronic pain should include efforts to strengthen the patient-provider relationship by attending to differences in patients' willingness to engage in patient-directed care and emphasizing shared decision-making.
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. tehc@upmc.edu
authors.forename: Carrie F
authors.initials: CF
authors.lastname: Teh
authors.forename: Jordan F
authors.initials: JF
authors.lastname: Karp
authors.forename: Arthur
authors.initials: A
authors.lastname: Kleinman
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds Iii
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000368:Aged; D002908:Chronic Disease; D006801:Humans; D007407:Interviews as Topic; D059408:Pain Management; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D024382:Professional Role; D011369:Professional-Patient Relations