title: Examining influential factors in providers' chronic pain treatment decisions: a comparison of physicians and medical students.
abstract: BACKGROUND
  Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers' chronic pain treatment decisions. A secondary aim was to examine differences across participant training level.
  
  
  METHODS
  Eighty-five participants (35 medical students, 50 physicians) made treatment decisions for 16 computer-simulated patients with chronic pain. Participants then selected from provided lists the information they used and the information they would have used (had it been available) to make their chronic pain treatment decisions for the patient vignettes.
  
  
  RESULTS
  Frequency analyses indicated that most participants reported using patients' pain histories (97.6 %) and pain description (95.3 %) when making treatment decisions, and they would have used information about patients' previous treatments (97.6 %) and average and current pain ratings (96.5 %) had this information been available. Compared to physicians, medical students endorsed more frequently that they would have used patients' employment and/or disability status (p < 0.05). A greater proportion of medical students wanted information on patients' use of illicit drugs and alcohol to make treatment decisions; while a greater proportion of physicians reported using personal experience to inform their decisions.
  
  
  CONCLUSIONS
  This study found providers use patients' information and their own experiences and intuition to make chronic pain treatment decisions. Also, participants of different training levels report using different patient and personal factors to guide their treatment decisions.
  
  
  CONCLUSIONS
  These results highlight the complexity of chronic pain care and suggest a need for more chronic pain education aimed at medical students and practicing providers.
authors.affiliation: Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford, Indianapolis, IN, 46202, USA. nahollin@iupui.edu.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Hollingshead
authors.affiliation: Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford, Indianapolis, IN, 46202, USA. smeints@iupui.edu.
authors.forename: Samantha
authors.initials: S
authors.lastname: Meints
authors.affiliation: Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford, Indianapolis, IN, 46202, USA. skmiddle@iupui.edu.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Middleton
authors.affiliation: Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford, Indianapolis, IN, 46202, USA. cfree@iupui.edu.
authors.forename: Charnelle A
authors.initials: CA
authors.lastname: Free
authors.affiliation: Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford, Indianapolis, IN, 46202, USA. athirsh@iupui.edu.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Hirsh
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D000066491:Clinical Decision-Making / Q000379:methods*; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000592:standards* / Q000639:trends; D010820:Physicians / Q000706:statistics & numerical data*; D012494:Sampling Studies; D012720:Severity of Illness Index; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult