Shared decision-making in the selection of outpatient analgesics for older individuals in the emergency department

Abstract

Objectives: To assess the relationship between older adults' perceptions of shared decision-making in the selection of an analgesic to take at home for acute musculoskeletal pain and (1) patient satisfaction with the analgesic and (2) changes in pain scores at 1 week.

Design: Cross-sectional study.

Setting: Single academic emergency department.

Participants: Individuals aged 65 and older with acute musculoskeletal pain.

Measurements: Two components of shared decision-making were assessed: information provided to the patient about the medication choice and patient participation in the selection of the analgesic. Optimal satisfaction with the analgesic was defined as being "a lot" satisfied. Pain scores were assessed in the ED and at 1 week using a 0-to-10 scale.

Results: Of 159 individuals reached by telephone, 111 met all eligibility criteria and completed the survey. Fifty-two percent of participants reported receiving information about pain medication options, and 31% reported participating in analgesic selection. Participants who received information were more likely to report optimal satisfaction with the pain medication than those who did not (67% vs 34%; P < .001). Participants who participated in the decision were also more likely to report optimal satisfaction with the analgesic (71% vs 43%; P = .008) and had a greater average decrease in pain score (4.1 vs 2.9; P = .05). After adjusting for measured confounders, participants who reported receiving information remained more likely to report optimal satisfaction with the analgesic (63% vs 38%; P = .04).

Conclusion: Shared decision-making in analgesic selection for older adults with acute musculoskeletal pain may improve outcomes.

Conflict of interest statement

Conflict of Interest: The authors do not have any conflict of interest related to this subject matter. This work was supported by National Center for Research Resources Grants KL2TR000084 and UL1 RR025747 (Platts-Mills, Buchbinder, Weaver), K12 HS19468-01 (Kistler), and National Institute on Aging Grant 5T35AG038047-02 through the UNC-CH Summer Research in Aging for Medical Students Program (Isaacs).

© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Figures

Figure 1

Patient Enrollment Flow Chart