! Chronic non-cancer pain is one of the most common diagnoses in primary care. Despite questionable benefits, there are now ~10 million users of long-term opioid therapy for chronic pain. National guidelines recommend tapering opioids when risks outweigh benefits. However, current interventions only engage a minority of the population that may benefit from tapering opioids. In addition, few of these interventions are based in primary care settings where the vast majority of opioids are prescribed. Thus, there is a critical need for effective tailored behavioral interventions to enhance patients' willingness to taper in primary care settings among those at high risk for opioid misuse. I hypothesize that by innovatively combining motivational interviewing and shared decision making approaches, behavioral interventions can prime patients to engage in tapering discussions by addressing their motivations for continued opioid use and identifying preferred options for tapering. By designing patient-centered interventions tailored to patients' beliefs, motivations, and preferences, we may be more effective at tapering patients' opioid doses in a way that mitigates potential unintended harms of reduced opioid prescribing. This proposal consists of three research aims.
The first aim i ncludes developing an easily actionable web-based survey to understand and elicit the full spectrum of reasons patients continue to use opioids; and assess what patients understand and prefer among available treatments (e.g. buprenorphine assisted, non- pharmacologic modalities such as cognitive behavioral therapy or yoga) to support safe opioid dose reduction.
The second aim focuses on developing an e-health behavioral intervention using a web-platform utilizing findings from the survey in aim 1 to design and deliver tailored feedback to patients and primary care physicians prior to a primary care clinic visit to optimize communication around opioid tapering during regular primary care visits.
Aim 3 is a pilot trial to evaluate the feasibility and acceptability of the intervention. This Mentored Patient-Oriented Career Development Award will provide the candidate with the in-depth training necessary to develop tailored patient-centered behavioral interventions to engage patients in cessation efforts for commonly abused prescription medications. The career development plan outlined in this proposal has three primary components: (1) training in measurement of beliefs, values, and preferences, (2) training in behavioral intervention development, and (3) training in mixed-methods evaluations. This proposal is supported by a highly experienced multidisciplinary mentorship team.
Long-term opioid use remains common in primary care patients despite questionable benefits. Current interventions to taper opioids typically enroll a minority of willing patients and fail to address the critical first step of securing patient engagement from those that may be resistant to the idea of tapering. The overarching goal of this proposal is to develop an e-health patient-centered behavioral intervention to assess and address patient motivations for continued opioid and preferences for tapering strategies to enhance engagement in opioid dose reduction in primary care settings.
