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Factors Associated with Clinician Intention to Address Diverse Aspects of Pain in Seriously Ill Outpatients.

Factors Associated with Clinician Intention to Address Diverse Aspects of Pain in Seriously Ill Outpatients.

Pain Med. 2010 Aug 30;

Authors: Shugarman LR, Asch SM, Meredith LS, Sherbourne CD, Hagenmeier E, Wen L, Cohen A, Rubenstein LV, Goebel J, Lanto A, Lorenz KA

Abstract Background. Pain is a common, often undertreated problem among patients with palliative needs. Objectives. To evaluate clinician factors associated with intention to address diverse aspects of pain. Design. Clinicians reviewed a clinical vignette describing a frail elderly patient with advanced hormone-refractory metastatic prostate cancer, depression, and pain not on analgesic therapy. Clinicians were surveyed about their intentions for treatment. Participants. All 280 primary care and specialist clinicians working in 19 hospital and community-based primary care, oncology, and cardiology clinics at eight geographically dispersed sites in two large VA hospital systems. Main Measures. Endpoints were clinician intention to deliver guideline-concordant care: prescribe opioids/antidepressants, assess existential wellbeing, and offer mental health referral. Demographic and behavioral measures were evaluated in association with endpoints. Key Results. Of 208 (74%) responding practitioners, 189 were responsible for prescribing decisions. Of those, 86, 77, 75, and 69 were "very"/"somewhat likely" to prescribe opioids, antidepressants, refer to a mental health specialist, or assess existential wellbeing, respectively. Factors associated with greater intent to prescribe an opioid or antidepressant included female gender, being an attending physician, being a primary care clinician, and greater confidence in pain management skills. Greater trust in the validity of pain ratings was associated with intent to prescribe an antidepressant and assess existential wellbeing. Prescribing opioids was less likely if perceived as an administrative burden. Assessing existential wellbeing was less likely if time constraints were perceived a barrier to evaluating pain. Female gender was the only factor associated with intent to refer to a mental health specialist. Conclusions. Our findings suggest useful targets for improving pain management include bolstering clinician confidence in pain management and their trust in pain ratings.

PMID: 20807347 [PubMed - as supplied by publisher]

Physician identification and management of psychosocial problems in primary care.

Physician identification and management of psychosocial problems in primary care.

J Clin Psychol Med Settings. 2010 Jun;17(2):103-15

Authors: Steele MM, Lochrie AS, Roberts MC

Often the burden of identifying children with behavioral or developmental problems is left up to the primary care physician (PCP). However, previous literature shows that PCPs consistently underidentify children with developmental/behavioral problems in pediatric primary care. For the current study, questionnaires containing three vignettes followed by questions addressing common psychosocial problems, general questions about their practice and training, and the Physician Belief Scale were distributed to physicians. Results indicated that physicians were better at identifying severe problems, had more difficulty identifying psychosocial problems with mild symptomatology, and tended to refer to a medical specialist or mental health professional more often for severe problems, depression or a developmental problem. Physicians tended to view treating psychosocial problems favorably.

PMID: 20162341 [PubMed - indexed for MEDLINE]

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