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The Practitioner Proposes a Treatment Change and the Patient Declines: What to do next?
Author(s) -
Falzer Paul R.,
Leventhal Howard L.,
Peters Ellen,
Fried Terri R.,
Kerns Robert,
Michalski Marion,
Fraenkel Liana
Publication year - 2013
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2012.00573.x
Subject(s) - dialog box , medicine , opposition (politics) , behaviour change , clinical psychology , physical therapy , intervention (counseling) , psychiatry , world wide web , computer science , political science , law , politics
Objective: This study describes how pain practitioners can elicit the beliefs that are responsible for patients’ judgments against considering a treatment change and activate collaborative decision making. Methods: Beliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about the significance of pain on the patient’s life. The items were aggregated into 4 decision models that predict which patients are actually considering a change in their current treatment. Results: While only 34% of study participants were considering a treatment change overall, the percentage ranged from 20 to 70, depending on their ratings about current consequences of pain, emotional influence, and long‐term impact. Generalized linear model analysis confirmed that a simple additive model of these 3 beliefs is the best predictor. Conclusion: Initial opposition to a treatment change is a conditional judgment and subject to change as specific beliefs become incompatible with patients’ current conditions. These beliefs can be elicited through dialog by asking 3 questions.