title: A mixed methods study of patient-provider communication about opioid analgesics.
abstract: OBJECTIVE
  To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients.
  
  
  METHODS
  We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients.
  
  
  RESULTS
  48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n=28, 58%) and ended by the providers (n=36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n=13) of encounters, no decision was made. Fewer than half of providers (n=20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR=0.51, 95% CI: 0.27-0.95) when opioids were discussed.
  
  
  CONCLUSIONS
  Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients.
  
  
  CONCLUSIONS
  Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management.
authors.affiliation: Johns Hopkins University, Baltimore, USA.
authors.forename: Helen Kinsman
authors.initials: HK
authors.lastname: Hughes
authors.affiliation: Oregon Health Sciences University, Portland, USA.
authors.forename: Philip Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Oregon Health Sciences University, Portland, USA; Portland VA Medical Center, Portland, USA.
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.affiliation: Wayne State University, Detroit, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Eggly
authors.affiliation: St. Lukes - Roosevelt, New York, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sharp
authors.affiliation: Wayne State University, Detroit, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohn
authors.affiliation: Johns Hopkins University, Baltimore, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.affiliation: Johns Hopkins University, Baltimore, USA. Electronic address: mcbeach@jhmi.edu.
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D036301:Qualitative Research; D013637:Tape Recording
chemical_list: D000701:Analgesics, Opioid
keywords: Communication; Mixed methods; Pain