title: The practitioner proposes a treatment change and the patient declines: what to do next?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA. paul.falzer@yale.edu
authors: Paul R
authors: PR
authors: Falzer
authors: Howard L
authors: HL
authors: Leventhal
authors: Ellen
authors: E
authors: Peters
authors: Terri R
authors: TR
authors: Fried
authors: Robert
authors: R
authors: Kerns
authors: Marion
authors: M
authors: Michalski
authors: Liana
authors: L
authors: Fraenkel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000628:therapy*; D003657:Decision Making; D034462:Dissent and Disputes; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D011369:Professional-Patient Relations; D055815:Young Adult