Clinician Interview Guide

Attachment D. Clinician Interview Guide

Form Approved

OMB No: xxxx-xxxx

Exp. Date: xx-xx-xxxx

Public Reporting burden of this collection of information is estimated at 60 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn:  PRA (xxxx-xxxx).

Introduction 

 

Hello, I’m (NAME) from Abt Global. Thank you for taking the time to speak with me.

As a reminder, in 2022 the Centers for Disease Control and Prevention (CDC) released the Clinical Practice Guideline for Prescribing Opioids for Pain, which provided up to date evidence regarding pain management approaches and emphasizes the need for prescribers to be focused on patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. For shorthand, we call it the 2022 CDC Clinical Practice Guideline throughout this interview.

General Dynamics Information Technology (GDIT) and Abt Global are conducting a research study for the CDC to better understand the adoption, implementation and outcomes of the 2022 CDC Clinical Practice Guideline on evidence-based care for pain management.

This interview aims to better understand your experiences as a clinician with managing patients’ pain and implementing pain management policies and guidelines, and the effects of these policies and guidelines on patient outcomes. This study is funded by the CDC.

Before we begin, I want to read a few points about this interview:

• Participation in this interview is voluntary.

• You will receive a $100 virtual gift card for participating in this interview.

• Your answers will not be connected to any information that could individually identify you, such as your name in any internal CDC reports or publicly-facing publications.

• You can decline to answer any question, without affecting your continued participation in the interview or your relationship with the CDC. There is a small risk of loss of privacy. We have many procedures in place to reduce this risk.

• This interview will last approximately 60 minutes.

We also would like to record the interview, so we do not miss anything. The recording will not be shared with anyone outside Abt Global, GDIT or CDC. We will use this recording to make de-identified transcripts of the recordings, which will be shared with GDIT and CDC. This recording will be deleted once our notes from the interview have been completed. 

Do any of you have any questions before we get started?

Do I have your consent to participate in this interview? Yes _____ No _____

May we record this interview? Yes _____ No _____

INDIVIDUAL APPROACH TO PAIN AND OPIOID MANAGEMENT

SAY: I’m going to ask a few questions about your management of patients who have acute, subacute, or chronic pain.

1. Let’s start with you describing your current approach to managing patients who have acute, subacute, or chronic pain.

PROBES: How do you discuss goals of pain management? Discuss treatment options? Discuss risks/benefits of opioids? What is your first line for pain management? Does your approach differ depending on the type of pain (i.e., acute, subacute, chronic)? Is your approach different if the patient suffers from chronic pain?

2. Tell me about a time when you had a patient with an acute condition and discussed treatment options for pain, including the risks/benefits of opioid therapy? How did you approach the situation?

3. Tell me about a time when you had a new patient who was on what you consider to be a high dosage of opioids? How did you approach the situation.

4. In what situations would you not feel comfortable providing pain management?

5. In what situations would you not feel comfortable using opioids for pain management?

6. Tell me about a recent time when you determined that the most appropriate option for a patient on long term opioid therapy was to consider a taper. How did you approach the taper with the patient?

PROBES: How did you engage the patient in the decision of whether to taper?

• How, if at all, was the patient involved in considering whether and how to taper (e.g., which doses to start with and how quickly)?

• Broadly, what was the tapering schedule?

• How did the patient respond (e.g., was there resistance, was there fear/apprehension, was there excitement or interest to taper)?

• How was the patient’s pain managed?

• How does this encounter differ from others you've had? Or is this an example of your usual encounters for tapering?

PRACTICE/HEALTH SYSTEM APPROACH TO PAIN MANAGEMENT

SAY: I’m now going to ask a few questions about your practice or health system’s policies, processes, procedures, and supports that are in place to manage patients with acute, subacute, or chronic pain.

7. What specific protocols, policies, or guidelines does your practice or health system have for pain management? What about for opioids, specifically?

PROBES: Treatment agreements, tapering policies, involvement of behavioral health in prescribing opioids

8. What supports does your practice/health system have to help patients manage acute, subacute, or chronic pain? How do patients access these supports (e.g., are they available)?

PROBES: Interdisciplinary/multidisciplinary team; alternative therapies; integrated behavioral health; dedicated pain clinic.

IMPLEMENTATION SUPPORT

SAY: I’m now going to ask a few questions about YOU and YOUR organization’s role in supporting the roll out, awareness, and uptake of the 2022 CDC Clinical Practice Guideline with clinicians and in clinical practices.

9. In 2022, the CDC released its 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain. How did you learn of the 2022 CDC Clinical Practice Guideline?

PROBES: Communication from your health system? Communication from other agencies? Communication from CDC?

10. What is your general sense of the 2022 CDC Clinical Practice Guideline and its recommendations?

11. What, if anything, has changed in your practice or health system because of the 2022 CDC Clinical Practice Guideline? What, if anything, has changed in your own approach to care?

PROBES: Which of the Guideline recommendations were implemented? If there were changes in your practice how were those changes implemented? What supports did you receive for the changes? What challenges did you experience with the changes?

12. From your perspective, how has the 2022 CDC Clinical Practice Guideline been received within the medical community?

13. It's been about two years since the 2022 CDC Clinical Practice Guideline was rolled out. In this time have you observed any benefits and challenges for patients? What about benefits or challenges for clinicians? Any unintended consequences? If yes, please share some details or examples.

14. What, if any, has been the reaction from patients to any practice changes that resulted from the 2022 CDC Clinical Practice Guideline?

15. What, if any, has been the reaction from caregivers to any practice changes that resulted from the 2022 CDC Clinical Practice Guideline?

16. Part of the 2022 CDC Clinical Practice Guideline’s aim was to re-emphasize the need for patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. Do you think the recommendations in the 2022 CDC Clinical Practice Guideline facilitate accomplishing these goals? Let’s walk through each one…

FOLLOW-UPS: Does implementing the recommendations from the 2022 CDC Clinical Practice Guideline…

• Promote patient-centered care? In what ways?

• Encourage shared decision making between patients and clinicians? In what ways?

• Improve equitable care for those in pain? In what ways?

• Address inequities between patients, or in patient care more generally? In what ways?

• Allow for needed flexibility for clinicians as they care for patients in pain? In what ways?

• Are there specific recommendations that do NOT achieve some of these goals? Why not?

17. What have been some of the barriers to implementation of practice changes as a result of the guideline? What have been the facilitators to implementation?

18. What are some changes you have seen (positive or negative; intended or unintended) in clinical practice since the release of the 2022 CDC Clinical Practice Guideline that you weren't expecting?

RECOMMENDATIONS OR LESSONS LEARNED

Thinking about the release of the 2022 CDC Clinical Practice Guideline overall…

19. What are some of the key takeaways or lessons learned from implementing the recommendations in the 2022 CDC Clinical Practice Guideline?

PROBES: Any takeaways or lessons learned from YOUR experiences, with the 2022 CDC Clinical Practice Guideline?

20. Before we conclude today’s interview, is there anything else that you would like to share?

21. Are there any questions before we wrap up? [Address questions]