Randomized trial of web-based training about opioid therapy for chronic pain.
OBJECTIVE
The treatment of chronic noncancer pain with chronic opioid therapy has increased rapidly, but medicine residents receive little training concerning this therapy. Therefore we conducted a trial to determine if an interactive web-based training focusing on shared decision-making for chronic opioid therapy improves knowledge and competence compared with exposure to practice guidelines.


METHODS
A randomized controlled educational trial of 213 internal medicine residents from 5 medicine residencies participating in the Residency Review Committee for Internal Medicine's Educational Innovations Project comparing access to interactive web-based training (COPE: Collaborative Opioid Prescribing Education) or access to the Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. Pretraining and immediate posttraining knowledge test; pretraining and 60-day posttraining self-reported competence, satisfaction, patient-centeredness, and selected clinical behaviors were analyzed using t tests, Pearson chi, and Generalized Estimating Equations.


RESULTS
The web training group had greater increase in knowledge with training (chi(2)=72.06, P<0.00001) and greater self-rated competence in the management of outpatients with chronic pain (chi(2)=6.48, P=0.01), and specifically in the use of opioids in this management (chi(2)=5.17, P=0.02). Residents in both groups reported more satisfaction with managing chronic pain care after training (chi(2)=52.72, P<0.0001), though the web training was superior on subscales concerning training adequacy (chi(2)=4.94, P=0.026) and relationship quality (chi(2)=5.79, P=0.016).


CONCLUSIONS
Exposure to an interactive web-based training focused on shared decision-making and communication skills was more effective than exposure to compatible practice guidelines for knowledge and self-reported competence in the management of chronic noncancer pain.
Sullivan
Mark D
MD
Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98195, USA. sullimar@u.washington.edu
Gaster
Barak
B
Russo
Joan
J
Bowlby
Lynn
L
Rocco
Nicole
N
Sinex
Noelle
N
Livovich
Jeffrey
J
Jasti
Harish
H
Arnold
Robert
R
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001294:Attitude to Health; D016009:Chi-Square Distribution; D002908:Chronic Disease / Q000188:drug therapy; D002986:Clinical Trials as Topic / Q000379:methods*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D020407:Internet; D007396:Internship and Residency; D017063:Outcome Assessment, Health Care / Q000379:methods; D010146:Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid