Difficult Encounters in Pain Medicine

Completed

• Conditions: Chronic Pain
• Interventions: Other: Pain treatment

• Registration Number: NCT05585619
• Lead Sponsor: Johns Hopkins University

Brief Summary

The investigators are seeking to determine factors associated with difficult patient encounters in an academic pain clinic. The investigators are examining 36 different variables to determine the association with "difficult" patient encounters as independently rated by a trainee and attending physician.

Detailed Description

Pain is associated with significant psychosocial pathology include axis 1 diagnoses, opioid use and misuse, unemployment, and strained relationships, and treatments for chronic pain are often ineffective. Collectively, these factors may result in a higher prevalence of patients characterized as 'difficult', which can lead to missed diagnoses, barriers to care resulting in poorer outcomes (professional pessimism, mistrust, passive treatment, referrals to other providers or discharge), patient complaints and 'HERO' events, avoidable legal claims, and increased risk of professional burnout. Characterizing patients as "difficult" (instead of encounters) may have negative consequences for future care, and there are few studies that have explored patients' perspectives on "difficult" encounters. Although several articles have narratively explored this issue, there are few targeted at chronic pain patients, and no studies in this population that set out to determine what variables are associated with a "difficult encounter", the congruence between patients' and providers' impressions of an encounter, or whether difficult encounters are associated with pain treatment outcome.

Study Timeline

• Study Start: 2022-10-10
• Study First Submitted: 2022-10-14
• Study First Submitted QC: 2022-10-14
• Study First Posted: 2022-10-19
• Primary Completion: 2023-12-15
• Study Completion: 2024-03-29
• Status Verified: 2024-05
• Last Update Submitted: 2024-05-09
• Last Update Posted: 2024-05-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 428

Inclusion Criteria

• ≥ 18 years of age
• Pain duration > 3 months
• New Visit (or no visit within 3 years)

Exclusion Criteria

• Referral only for diagnostic procedure
• Friend or relative, or direct referral from friend or relative

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Chronic pain patients	Pain treatment	New chronic pain consults seen by a trainee and attending pain physician

Primary Outcome Measures

Name	Time	Method
Difficulty of encounter as rated by trainee	Immediately after consult	Difficulty of encounter as rated by a 6-point Likert scale (1=very pleasant, 6=extremely difficult)
Difficulty of encounter as rated by attending physician	Immediately after consult	Difficulty of encounter as rated by a 6-point Likert scale (1=very pleasant, 6=extremely difficult)

Secondary Outcome Measures

Name	Time	Method
Pain score	1-2 months post-treatment	0-10 numerical pain scale (0=no pain, 10= worst pain imaginable)
Number of side effects	1-2 months post-treatment	Side effects from medications or complications from procedures
Categorical success	1-2 months post-treatment	Binary measure of success (2-point or greater decrease in average pain score coupled with a score of 5 or greater on Patient global impression of change scale)
Appointment status	1-2 months post-treatment	Showed up on time or showed up late or missed appointment
Patient global impression of change	1-2 months post-treatment	1-7 Likert scale (1=no change or worse, 7=a great deal better)

Trial Locations

Locations (1)

Johns Hopkins School of Medicine; 🇺🇸 Baltimore, Maryland, United States