改善关于疼痛和阿片类药物的沟通

实验性的：Clinicians - Communication skills training

Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail.

行为的：Clinicians - Communication skills training

Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient

有源比较器：Clinician Control

Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control.

其他：Clinician Control

Physician will review materials based on CDC opioid prescribing guidelines.

实验性的：Patient seeing trained clinician

Patients taking opioids for chronic pain who are established clinic patients and have an appointment with a clinician who has received the communication training will be recruited for this arm.

行为的：Patient seeing trained clinician

patient with a scheduled visit with a clinician who received the communication training.

有源比较器：Patient seeing control clinician

Patients taking opioids for chronic pain who are established clinic patients and have an appointment with a clinician who has NOT received the communication training (Clinician control group) will be recruited for this arm.

其他：Patient seeing control clinician

patient with a scheduled visit with a clinician who did not receive the communication training.

Clinician Number of Targeted Behaviors Per Visit

Compare frequency of use of targeted communication behaviors observed per visit for residents in the Intervention vs Control arm (using coding of recorded visits to assess skill use). We first developed a list of targeted communication behaviors that were targeted by our intervention and based on our conceptual model. We developed a coding manual to count the number of unique behaviors in each study visit. We analyzed audio recordings and transcripts from all study visits to count the number of targeted behaviors per each visit. Multiple team members measured communication behaviors in each visit to ensure reliability of this measure.

Compare Efficacy of Control vs Intervention by Measuring Changes in the Way Pain Interfered With Patients Lives Using the Brief Pain Inventory - Pain Interference Subscale Survey

Brief Pain Inventory (BPI) Pain Interference subscale consists of 7 categories relating to how pain interferes with patients' lives. Patients are asked to rate their pain on a zero (Does Not Interfere) to 10 (Completely Interferes) scale. The 7 categories are: 1. General Activity, 2. Mood, 3. Walking Ability, 4. Work, 5. Relationships, 6. Sleep, 7. Enjoyment of life. Results are averaged to give an overall interference rating from 0-10, with higher scores indicating worse pain.

Compare Efficacy of Control vs Intervention by Measuring Changes in the Severity of Patients Pain Using the Brief Pain Inventory - (Short Form) Pain Severity Subscale Which Measures the Severity of the Patient's Pain.

Brief Pain Inventory (BPI) Short Form -- Pain Severity subscale has 4 survey questions / categories, asking patients to rate the severity of their pain on a 0-10 scale (with 0 being No Pain and 10 being Worst Possible Pain). The 4 Categories are, A. At it's worst in the last 24 hours, B. At it's best in the last 24 hours, C. Pain on average, D. Pain right now. Results are averaged to give an overall score (0-10) with higher scores indicating worse outcomes.

Difficult Doctor-Patient Relationship Questionnaire

Comparison of difficult doctor-patient encounter scale for Intervention vs Control physicians. Difficult doctor-patient relationship scale has 10 items scored from 1-6. The overall scale range is 10-60, with higher values indicating more difficult (worse) visits. Physicians complete this measure for each study patient.

Patient Experience Score

Patient experience score for patients who saw Intervention and Control physicians, measured by post visit patient agreement with treatment plan, patient trust, and patient assessment of clinician communication skills. Patient experience is a standardized composite average of three validated scales:

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Adult Visit Survey communication subscale, range 0 to 12, with higher scores indicating better communication.

Patient Agreement with Treatment Plan Scale, range 3 to 21, with higher scores indicating greater agreement.

Brief Wake Forest Physician Trust Scale, range 5 to 25, with higher scores indicating greater trust.

The three scales were standardized and averaged into a single composite score. The theoretical composite score ranges from -4.5 to 0.6, with higher scores indicating a better patient experience. Results are reported separately for each study arm as mean (standard deviation).

Physicians' Overall Appraisal of the Standardized Patient Intervention

Physician reported assessment of intervention. Investigators will ask for physicians' evaluation of the feasibility, acceptability, and utility of the intervention. Investigators will offer 10 value statements about the intervention. Physicians will select 1 from the following choices: strongly agree, agree, neutral, disagree, strongly disagree. Results will be reported as the percentage who agree or strongly agree with each statement.

Physician Communication Self-efficacy

Physician self-efficacy for communication skills for Intervention vs Control physicians. These questions ask about physicians' confidence related to managing chronic non-cancer pain in primary care. Physicians will be asked to rate how strongly they agree or disagree with 8 statements (each on 1-5 scale. Higher values indicate greater (better) self-efficacy. Baseline and post-visit ratings of self efficacy will be computed, and we will measure change in self efficacy (post-visit self efficacy minus baseline self efficacy) for Control vs Intervention physicians. Overall score range will be 1-5, with higher numbers indicating better self efficacy.

High-risk Opioid Prescribing

Prevalence of high-risk opioid prescribing as measured by chart review; defined either as being prescribed 90MME or more OR being prescribed opioids plus benzodiazepines 2 months after study completion based on chart review