A Multicentered Randomized Controlled Trial Comparing the Effectiveness of Pain Treatment Communication Tools in Emergency Department Patients With Back or Kidney Stone Pain

Abstract

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = −2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. (Am J Public Health. 2022;112(S1):S45–S55. https://doi.org/10.2105/AJPH.2021.306511 )

Patient Perceptions About Opioid Risk Communications Within the Context of a Randomized Clinical Trial

“…Altogether, these results provide insight into the quantitative results from the trial published previously. 12 One of the primary outcomes of the RCT was ability to accurately recall one’s risk score after receiving the risk tool; overall, rates of accurate recall for both risk intervention groups were low (38.8% for those who received the probabilistic risk tool alone and 43.7% for those who received the narrative-enhanced probabilistic risk tool). 12 A possible explanation for these low rates of recall could be that self-identity—for example, identifying as someone who does not “do pills”—renders risk information less relevant.…”

“… 12 One of the primary outcomes of the RCT was ability to accurately recall one’s risk score after receiving the risk tool; overall, rates of accurate recall for both risk intervention groups were low (38.8% for those who received the probabilistic risk tool alone and 43.7% for those who received the narrative-enhanced probabilistic risk tool). 12 A possible explanation for these low rates of recall could be that self-identity—for example, identifying as someone who does not “do pills”—renders risk information less relevant. Another outcome from the RCT was that the risk interventions led to high levels of satisfaction and perceived shared decision-making; these quantitative results align with our qualitative findings of participant engagement with the risk communication interventions.…”

“…Depending on the participants’ responses to the ORT, they could be categorized as at risk ( Figure 1 ), at high risk ( Figure 2 ), and at highest risk ( Figure 3 ) for future opioid misuse. 16 …”

“…Depending on the participants' responses to the ORT, they could be categorized as at risk (Figure 1), at high risk (Figure 2), and at highest risk (Figure 3) for future opioid misuse. 16 Participants in the third group received the narrative-enhanced probabilistic risk tool and were asked to watch narrative videos in addition to receiving the probabilistic risk tool. Participants viewed eight 1-to 3-minute videos of patients discussing their experiences with pain treatment and opioids (eAppendix and eTables 1 and 2 in the Supplement).…”

“…[8][9][10][11] The Life Stories for Opioid Risk Reduction in the ED (Life STORRIED) clinical trial was a Patient-Centered Outcomes Research Institute (PCORI)-funded randomized clinical trial (RCT) conducted to understand how to communicate risks related to opioid prescriptions while placing some of the decision-making power back into the hands of patients. 12 The aim of this trial was to engage patients who presented to the emergency department (ED) with either musculoskeletal back or neck pain or renal colic in a shared decision-making process incorporating their values and preferences into their pain management decisions after their ED visit. Presenting quantitative risk information in an engaging and easy-to-understand format is challenging, and the value of using narratives to communicate this information is still largely unknown.…”