Hieu-Pham/cpgQA huggingface dataset:
Features and overview

This OT CPG is designed to assist healthcare providers in managing or co-managing patients on or being  considered for LOT. Specifically, this CPG is intended for adults, including Veterans as well as deployed and  non-deployed Active Duty Service Members, their beneficiaries, and retirees and their beneficiaries, with  chronic pain who are receiving care from the VA or DoD healthcare delivery systems. This CPG is not  intended for and does not provide recommendations for the management of pain with LOT in children or  adolescents, in patients with acute pain, or in patients receiving end-of-life care. As is so for any  pharmacotherapy, any decision about prescribing opioids, or alternative medications for pain, for pregnant  women should be made with due caution and cognizance of applicable U.S. Food and Drug Administration  (FDA) labeling. Any patient in the VA or DoD healthcare system should be offered access to the  interventions that are recommended in this guideline after taking into consideration the patient’s specific  circumstances.  

Question: What does this CPG not do?
Answer: does not provide recommendations for the management of pain with LOT in children or  adolescents, in patients with acute pain, or in patients receiving end-of-life care
Features and overview

While these guidelines are broadly recommended, their implementation is intended to be patient centered. Thus, treatment and care should take into account a patient’s needs and preferences. Good  communication between healthcare professionals and the patient about the patient’s pain experience,  treatment goals, and challenges is essential and should be guided by evidence-based information tailored  to the patient’s needs. An empathetic and non-judgmental (versus a confrontational or adversarial)  approach to communication with a patient is highly recommended in order to build trust and facilitate frank discussions relating to the social, economic, emotional, and cultural factors that influence patients’  perceptions, behaviors, and decision making. 

Question: What kind of approach is highly recommended for communication with a patient?
Answer: An empathetic and non-judgmental (versus a confrontational or adversarial)
Features and overview

While these guidelines are broadly recommended, their implementation is intended to be patient centered. Thus, treatment and care should take into account a patient’s needs and preferences. Good  communication between healthcare professionals and the patient about the patient’s pain experience,  treatment goals, and challenges is essential and should be guided by evidence-based information tailored  to the patient’s needs. An empathetic and non-judgmental (versus a confrontational or adversarial)  approach to communication with a patient is highly recommended in order to build trust and facilitate frank discussions relating to the social, economic, emotional, and cultural factors that influence patients’  perceptions, behaviors, and decision making. The information that patients are given about treatment and care should be culturally appropriate and  also available to people with limited literacy skills. It should also be accessible to people with additional needs such as physical, sensory, or learning disabilities. Family involvement should be considered if  appropriate. 

Question: Why is an empathetic and non-judgmental approach highly recommended for communication with a patient?
Answer: in order to build trust and facilitate frank discussions relating to the social, economic, emotional, and cultural factors that influence patients’  perceptions, behaviors, and decision making
Features and overview

The systematic review conducted for the update of this CPG encompassed interventional studies (primarily  randomized controlled trials [RCTs]) published between March 2009 and December 2016 and targeted nine key questions (KQs) focusing on the means by which the delivery of healthcare could be optimized for  patients on or being considered for LOT. Because a comprehensive review of the evidence related to LOT was not feasible, the nine selected KQs were prioritized from many possible KQs. Therefore, many of the  2010 OT CPG recommendations were considered for inclusion in the updated version of the guideline  without an updated review of the evidence. The section on Recommendations delineates whether or not  the current CPG recommendations were based on an updated evidence review. Appendix H delineates  whether the 2010 OT CPG recommendations were considered for inclusion in the update based on an  updated evidence review or based on the evidence included in the 2010 OT CPG. The section on  Recommendation Categorization further describes the methodology used for the categorization.  

Question: Why only nine key questions (KQs) were prioritized from many possible KQs?
Answer: Because a comprehensive review of the evidence related to LOT was not feasible
Features and overview

The 2017 version of the VA/DoD OT CPG is the second update to the original CPG. It provides practice  recommendations for the care of populations with chronic pain already on or being considered for LOT.  Although there are many other approaches to the treatment of chronic pain, the scope of this CPG is to  focus on the use of opioids for chronic pain rather than being comprehensive about all treatment options.  A particular strength of this CPG is the multidisciplinary stakeholder involvement from its inception,  ensuring representation from the broad spectrum of clinicians engaged in the treatment and management  of patients with chronic pain on or being considered for LOT.  

Question: What does the 2017 version of the VA/DoD OT CPG provide?
Answer: practice  recommendations for the care of populations with chronic pain already on or being considered for LOT
Features and overview

The 2017 version of the VA/DoD OT CPG is the second update to the original CPG. It provides practice  recommendations for the care of populations with chronic pain already on or being considered for LOT.  Although there are many other approaches to the treatment of chronic pain, the scope of this CPG is to  focus on the use of opioids for chronic pain rather than being comprehensive about all treatment options.  A particular strength of this CPG is the multidisciplinary stakeholder involvement from its inception,  ensuring representation from the broad spectrum of clinicians engaged in the treatment and management  of patients with chronic pain on or being considered for LOT.  

Question: What is the scope of this CPG?
Answer: to  focus on the use of opioids for chronic pain rather than being comprehensive about all treatment options
Features and overview

The 2017 version of the VA/DoD OT CPG is the second update to the original CPG. It provides practice  recommendations for the care of populations with chronic pain already on or being considered for LOT.  Although there are many other approaches to the treatment of chronic pain, the scope of this CPG is to  focus on the use of opioids for chronic pain rather than being comprehensive about all treatment options.  A particular strength of this CPG is the multidisciplinary stakeholder involvement from its inception,  ensuring representation from the broad spectrum of clinicians engaged in the treatment and management  of patients with chronic pain on or being considered for LOT.  

Question: What is the strength of this CPG?
Answer: the multidisciplinary stakeholder involvement from its inception,  ensuring representation from the broad spectrum of clinicians engaged in the treatment and management  of patients with chronic pain on or being considered for LOT
Features and overview

The framework for recommendations in this CPG considered factors beyond the strength of the evidence,  including balancing desired outcomes with potential harms of treatment, equity of resource availability,  the potential for variation in patient values and preferences, and other considerations (see Methods for  more information). Applicability of the evidence to VA/DoD populations was also taken into consideration.  A structured algorithm (see Algorithm) accompanies the guideline to provide an overview of the  recommendations in the context of the flow of patient care and clinician decision making and to assist with  training providers. The algorithm may be used to help facilitate translation of guideline recommendations  into effective practice. 

Question: Which factors were considered for the framework for recommendations in this CPG?
Answer: balancing desired outcomes with potential harms of treatment, equity of resource availability,  the potential for variation in patient values and preferences, and other considerations
Features and overview

The current document is an update to the 2010 VA/DoD Clinical Practice Guideline for the Management of  Opioid Therapy for Chronic Pain. The methodology used in developing the 2017 CPG follows the VA/DoD  Guideline for Guidelines,[1] an internal document of the VA and DoD EBPWG. The VA/DoD Guideline for  Guidelines can be downloaded from http://www.healthquality.va.gov/policy/index.asp. This document  provides information regarding the process of developing guidelines, including the identification and  assembly of the Guideline Champions (“Champions”) and other subject matter experts from within the VA  and DoD, known as the “Work Group,” and ultimately, the development and submission of an updated OT  CPG. The VA Office of Quality, Safety and Value, in collaboration with the Office of Evidence Based  Practice, U.S. Army Medical Command, the proponent for CPGs for the DoD, identified two clinical leaders, Jack Rosenberg, MD, FASAM from the VA and Christopher Spevak, MD, MPH, JD from the DoD, as  Champions for the 2017 CPG.  

Question: What methodology was used in developing the 2017 CPG?
Answer: the VA/DoD  Guideline for Guidelines,[1] an internal document of the VA and DoD EBPWG
Features and overview

The current document is an update to the 2010 VA/DoD Clinical Practice Guideline for the Management of  Opioid Therapy for Chronic Pain. The methodology used in developing the 2017 CPG follows the VA/DoD  Guideline for Guidelines,[1] an internal document of the VA and DoD EBPWG. The VA/DoD Guideline for  Guidelines can be downloaded from http://www.healthquality.va.gov/policy/index.asp. This document  provides information regarding the process of developing guidelines, including the identification and  assembly of the Guideline Champions (“Champions”) and other subject matter experts from within the VA  and DoD, known as the “Work Group,” and ultimately, the development and submission of an updated OT  CPG. The VA Office of Quality, Safety and Value, in collaboration with the Office of Evidence Based  Practice, U.S. Army Medical Command, the proponent for CPGs for the DoD, identified two clinical leaders, Jack Rosenberg, MD, FASAM from the VA and Christopher Spevak, MD, MPH, JD from the DoD, as  Champions for the 2017 CPG.  

Question: What does the VA/DoD Guideline for Guidelines provide?
Answer: information regarding the process of developing guidelines, including the identification and  assembly of the Guideline Champions (“Champions”) and other subject matter experts from within the VA  and DoD, known as the “Work Group,” and ultimately, the development and submission of an updated OT  CPG
Features and overview

VA/DoD CPGs encourage clinicians to use a patient-centered care approach that is tailored to the patient’s  capabilities, needs, goals, prior treatment experience, and preferences. Regardless of setting, all patients in  the healthcare system should be offered access to evidence-based interventions appropriate to that  patient. When properly executed, patient-centered care may decrease patient anxiety, increase trust in  clinicians,[77] and improve treatment adherence.[78] Improved patient-clinician communication through  patient-centered care can be used to convey openness to discuss any future concerns.

Question: What does VA/DoD CPGs encourage clinicians to do?
Answer: to use a patient-centered care approach that is tailored to the patient’s  capabilities, needs, goals, prior treatment experience, and preferences
Features and overview

VA/DoD CPGs encourage clinicians to use a patient-centered care approach that is tailored to the patient’s  capabilities, needs, goals, prior treatment experience, and preferences. Regardless of setting, all patients in  the healthcare system should be offered access to evidence-based interventions appropriate to that  patient. When properly executed, patient-centered care may decrease patient anxiety, increase trust in  clinicians,[77] and improve treatment adherence.[78] Improved patient-clinician communication through  patient-centered care can be used to convey openness to discuss any future concerns.

Question: What should all patients in the healthcare system be offered?
Answer: access to evidence-based interventions appropriate to that  patient
Features and overview

VA/DoD CPGs encourage clinicians to use a patient-centered care approach that is tailored to the patient’s  capabilities, needs, goals, prior treatment experience, and preferences. Regardless of setting, all patients in  the healthcare system should be offered access to evidence-based interventions appropriate to that  patient. When properly executed, patient-centered care may decrease patient anxiety, increase trust in  clinicians,[77] and improve treatment adherence.[78] Improved patient-clinician communication through  patient-centered care can be used to convey openness to discuss any future concerns.

Question: What is the purpose of patient-centered care?
Answer: decrease patient anxiety, increase trust in  clinicians,[77] and improve treatment adherence
Features and overview

VA/DoD CPGs encourage clinicians to use a patient-centered care approach that is tailored to the patient’s  capabilities, needs, goals, prior treatment experience, and preferences. Regardless of setting, all patients in  the healthcare system should be offered access to evidence-based interventions appropriate to that  patient. When properly executed, patient-centered care may decrease patient anxiety, increase trust in  clinicians,[77] and improve treatment adherence.[78] Improved patient-clinician communication through  patient-centered care can be used to convey openness to discuss any future concerns.

Question: What can be used to convey openness to discuss any future concerns?
Answer: Improved patient-clinician communication through  patient-centered care
Features and overview

As part of the patient-centered care approach, clinicians should review the patient’s history including previous treatment approaches, their results, and any other outcomes with the patient. They should ask the patient about his or her willingness to accept a referral to an addiction or other behavioral health specialist when appropriate. Lastly, they should involve the patient in prioritizing problems to be addressed and in setting specific goals regardless of the selected setting or level of care. The below approach may be used in setting SMART (Specific, Measurable, Action Oriented, Realistic, Timed) goals for the patient (Table 1).

Question: What should the clinicians do as part of the patient-centered care approach?
Answer: review the patient’s history including previous treatment approaches, their results, and any other outcomes with the patient
Features and overview

As part of the patient-centered care approach, clinicians should review the patient’s history including previous treatment approaches, their results, and any other outcomes with the patient. They should ask the patient about his or her willingness to accept a referral to an addiction or other behavioral health specialist when appropriate. Lastly, they should involve the patient in prioritizing problems to be addressed and in setting specific goals regardless of the selected setting or level of care. The below approach may be used in setting SMART (Specific, Measurable, Action Oriented, Realistic, Timed) goals for the patient (Table 1).

Question: What should the clinicians ask the patient?
Answer: about his or her willingness to accept a referral to an addiction or other behavioral health specialist when appropriate
Features and overview

The shared decision making process for chronic pain treatment planning is based on the foundation of a  patient-centered assessment of risks and benefits and a clinical synthesis performed by the provider  (Figure 1). The patient-centered assessment incorporates a patient-centered interview, and exploration of  patient values, goals, questions, concerns, and expectations. Next, the clinician performs a biopsychosocial  assessment and determines clinically appropriate therapeutic options in which benefits are likely to  outweigh risks. The process culminates in a shared decision making process to develop a patient-centered  treatment plan by the patient selecting from the clinically appropriate treatment options generated in the  first two steps.  

Question: What is the basis of the shared decision making process for chronic pain treatment planning?
Answer: the foundation of a  patient-centered assessment of risks and benefits and a clinical synthesis performed by the provider
Features and overview

The shared decision making process for chronic pain treatment planning is based on the foundation of a  patient-centered assessment of risks and benefits and a clinical synthesis performed by the provider  (Figure 1). The patient-centered assessment incorporates a patient-centered interview, and exploration of  patient values, goals, questions, concerns, and expectations. Next, the clinician performs a biopsychosocial  assessment and determines clinically appropriate therapeutic options in which benefits are likely to  outweigh risks. The process culminates in a shared decision making process to develop a patient-centered  treatment plan by the patient selecting from the clinically appropriate treatment options generated in the  first two steps.  

Question: What does the patient-centered assessment incorporate?
Answer: a patient-centered interview, and exploration of  patient values, goals, questions, concerns, and expectations
Features and overview

There are electronic tools to facilitate clinical risk assessment and adherence to risk mitigation. Two tools  currently used in the VA are the Opioid Therapy Risk Report (OTRR) and the Stratification Tool for  Opioid Risk Mitigation (STORM). The OTRR allows VA providers to review clinical data related to opioid  pain treatment within the electronic medical record (EMR), providing an efficient way of monitoring the  data. The STORM tool incorporates co-occurring medical and mental health conditions, SUD, opioid dose,  co-prescribed sedatives, and information about prior adverse events and generates estimates of patients’  risk or hypothetical risk when considering initiation of opioid therapy. It quantifies risk for poisoning or  suicide-related events and for drug-related events, accidents, falls, and drug-induced conditions over a  three-year window. Further, it provides suggestions as to what alternative treatments have not been tried  and what risk mitigation strategies need to be applied. Evidence supporting their use is poor but they  facilitate providers’ determination of current, past and potential therapies and strategies.

Question: What can facilitate clinical risk assessment and adherence to risk mitigation?
Answer: There are electronic tools
Features and overview

There are electronic tools to facilitate clinical risk assessment and adherence to risk mitigation. Two tools  currently used in the VA are the Opioid Therapy Risk Report (OTRR) and the Stratification Tool for  Opioid Risk Mitigation (STORM). The OTRR allows VA providers to review clinical data related to opioid  pain treatment within the electronic medical record (EMR), providing an efficient way of monitoring the  data. The STORM tool incorporates co-occurring medical and mental health conditions, SUD, opioid dose,  co-prescribed sedatives, and information about prior adverse events and generates estimates of patients’  risk or hypothetical risk when considering initiation of opioid therapy. It quantifies risk for poisoning or  suicide-related events and for drug-related events, accidents, falls, and drug-induced conditions over a  three-year window. Further, it provides suggestions as to what alternative treatments have not been tried  and what risk mitigation strategies need to be applied. Evidence supporting their use is poor but they  facilitate providers’ determination of current, past and potential therapies and strategies.

Question: Which electronic tools are currently used in the VA?
Answer: the Opioid Therapy Risk Report (OTRR) and the Stratification Tool for  Opioid Risk Mitigation (STORM)
Features and overview

There are electronic tools to facilitate clinical risk assessment and adherence to risk mitigation. Two tools  currently used in the VA are the Opioid Therapy Risk Report (OTRR) and the Stratification Tool for  Opioid Risk Mitigation (STORM). The OTRR allows VA providers to review clinical data related to opioid  pain treatment within the electronic medical record (EMR), providing an efficient way of monitoring the  data. The STORM tool incorporates co-occurring medical and mental health conditions, SUD, opioid dose,  co-prescribed sedatives, and information about prior adverse events and generates estimates of patients’  risk or hypothetical risk when considering initiation of opioid therapy. It quantifies risk for poisoning or  suicide-related events and for drug-related events, accidents, falls, and drug-induced conditions over a  three-year window. Further, it provides suggestions as to what alternative treatments have not been tried  and what risk mitigation strategies need to be applied. Evidence supporting their use is poor but they  facilitate providers’ determination of current, past and potential therapies and strategies.

Question: What does the OTRR do?
Answer: allows VA providers to review clinical data related to opioid  pain treatment within the electronic medical record (EMR), providing an efficient way of monitoring the  data
Features and overview

There are electronic tools to facilitate clinical risk assessment and adherence to risk mitigation. Two tools  currently used in the VA are the Opioid Therapy Risk Report (OTRR) and the Stratification Tool for  Opioid Risk Mitigation (STORM). The OTRR allows VA providers to review clinical data related to opioid  pain treatment within the electronic medical record (EMR), providing an efficient way of monitoring the  data. The STORM tool incorporates co-occurring medical and mental health conditions, SUD, opioid dose,  co-prescribed sedatives, and information about prior adverse events and generates estimates of patients’  risk or hypothetical risk when considering initiation of opioid therapy. It quantifies risk for poisoning or  suicide-related events and for drug-related events, accidents, falls, and drug-induced conditions over a  three-year window. Further, it provides suggestions as to what alternative treatments have not been tried  and what risk mitigation strategies need to be applied. Evidence supporting their use is poor but they  facilitate providers’ determination of current, past and potential therapies and strategies.

Question: What does the STORM tool do?
Answer: incorporates co-occurring medical and mental health conditions, SUD, opioid dose,  co-prescribed sedatives, and information about prior adverse events and generates estimates of patients’  risk or hypothetical risk when considering initiation of opioid therapy. It quantifies risk for poisoning or  suicide-related events and for drug-related events, accidents, falls, and drug-induced conditions over a  three-year window. Further, it provides suggestions as to what alternative treatments have not been tried  and what risk mitigation strategies need to be applied.