title: Randomized trial of web-based training about opioid therapy for chronic pain.
abstract: 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.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98195, USA. sullimar@u.washington.edu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Barak
authors.initials: B
authors.lastname: Gaster
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Lynn
authors.initials: L
authors.lastname: Bowlby
authors.forename: Nicole
authors.initials: N
authors.lastname: Rocco
authors.forename: Noelle
authors.initials: N
authors.lastname: Sinex
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Livovich
authors.forename: Harish
authors.initials: H
authors.lastname: Jasti
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
mesh_terms: 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*
chemical_list: D000701:Analgesics, Opioid