Clinical trial NCT05585619: Difficult Encounters in Pain Medicine
Official title: Difficult Encounters in a Chronic Pain Setting: An Analysis of Factors Associated With "Difficult"
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Chronic Pain
Keywords: chronic pain
Lead sponsor: Johns Hopkins University
Sponsor class: OTHER
First posted: 2022-10-19
Enrollment: 428
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Chronic pain patients seen for a new consultation at the Johns Hopkins Blaustein Pain Treatment Center

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.

Eligibility criteria: 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

Primary outcomes:
measure: Difficulty of encounter as rated by trainee
timeFrame: Immediately after consult
measure: Difficulty of encounter as rated by attending physician
timeFrame: Immediately after consult
Secondary outcomes:
measure: Patient global impression of change
timeFrame: 1-2 months post-treatment
measure: Pain score
timeFrame: 1-2 months post-treatment
measure: Categorical success
timeFrame: 1-2 months post-treatment
measure: Appointment status
timeFrame: 1-2 months post-treatment
measure: Number of side effects
timeFrame: 1-2 months post-treatment
Other outcomes:
Locations:
city: Baltimore
country: United States
facility: Johns Hopkins School of Medicine
state: Maryland
Study officials:
affiliation: Johns Hopkins University
name: Steven P. Cohen, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Wasan AD, Wootton J, Jamison RN. Dealing with difficult patients in your pain practice. Reg Anesth Pain Med. 2005 Mar-Apr;30(2):184-92. doi: 10.1016/j.rapm.2004.11.005.
citation: Hinchey SA, Jackson JL. A cohort study assessing difficult patient encounters in a walk-in primary care clinic, predictors and outcomes. J Gen Intern Med. 2011 Jun;26(6):588-94. doi: 10.1007/s11606-010-1620-6. Epub 2011 Jan 25.