Module 2: Continuum of Care and Available Resources – Topic C Collaborate with persons using opioids to formulate mutually agreed upon goals, and methods of monitoring progress and evaluating outcomes.

Learning Objectives

By the end of this topic, the student should be able to:

• Describe the benefits and evidence related to collaboration among persons who use opioids or who are experiencing opioid use disorder (OUD) and the health and social service team in care planning, monitoring, and outcome evaluation.
• Discuss strategies for improved collaboration.
• List available tools and resources that enhance collaborative care planning, monitoring, and evaluation for persons using opioids or experiencing OUD.

Key Concepts

• Assessment includes the person’s assessment of their experience of pain and their goals and preferences for treatment.
• A comprehensive plan of care includes the identification of client preferences and goals.
• Strategies and tools exist that enhance care planning and improve collaboration.
• Validated guidelines recommend an individualized plan of care for each person experiencing opioid use and/or OUD.
• Monitoring and evaluating the process of care and outcomes need to be conducted based on the goals identified in collaborative planning.
• There is good evidence that creating safe clinical environments, developing rapport, and including people in collaborative care planning and evaluation has significant positive effects on treatment outcomes.

Comprehensive Assessment of Pain

Developing rapport and a trusting relationship between the person using opioids or experiencing OUD and the health and social service provider or team begins with a comprehensive assessment.

Research shows that persons receiving care have identified significant factors related to their developing trusting relationships with health and social service providers.

• One of these factors is a positive environment where people feel they can open up.
• Feeling cared for and feeling they are part of the care planning allows persons to feel safe, understood, and supported.

In these settings, people feel they can share their thoughts about treatment needs and preferences.

Collaborative Care Planning

Care planning begins by identifying management options—pharmaceutical and non-pharmaceutical—that the person seeking care and the health and social service provider can agree on. Education about pain, pain management options, and evaluation is an important tool in collaborative care planning.

• An initiative by the U.S. Patient-Centered Clinical Decision Support Learning Network focused on improving pain management, opioid use, and OUD treatment identified 19 client-centred interventions, including:
  • topic-specific, evidence-informed information for clients,
  • shared decision-making,
  • client portals and websites, and
  • pain management and opioid guidelines.

The initiative is aimed at enhancing client education, engagement, and collaborative decisions between persons using opioids and their care teams (Osheroff et al., 2019)

Randomized control trials have shown improved outcomes when the interprofessional team, persons experiencing pain, and their families collaborate in multi-modal care planning.

Evaluation should be based on mutually agreed upon goals and conducted routinely during the care experience, especially after changes in treatment.

Tools and Strategies

Strategies exist to enhance and encourage collaboration between health and social service providers and persons experiencing pain and/or opioid use disorder.

Establishing a trusting relationship is the antecedent to collaboration. It begins with the assessment process.

• Health and social service providers should adopt an open attitude and ensure a safe space for people to express themselves.
• Respectful and authentic communication is critical.

Pain scales such as the Brief Pain Inventory (BPI) are based on self-report and include functional status as well.

• The Patient-Centered Clinical Decision Support Learning Network recommend a symptom evaluation tool for the same purpose.
• The Centre for Effective Practice’s Opioid Use Disorder Tool (2018a) and Management of Chronic Non-cancer Pain Tool (2018b) include links to tools such as the BPI and other educational resources.

Questions

Health and social service providers can begin to develop rapport during which step in the care relationship?

a. planning

b. assessment

c. management

d. evaluation

Correct! During assessment, the therapeutic relationship can be initiated by developing rapport.

Incorrect. The correct answer is b. During assessment, the therapeutic relationship can be initiated by developing rapport.

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Evaluation is the responsibility of health and social service providers and conducted when the treatment process is concluded.

a. true

b. false

Correct! Evaluation addresses the agreed upon goals of treatment, and is conducted routinely throughout the process of care.

Incorrect. The correct answer is b. Evaluation addresses the agreed upon goals of treatment, and is conducted routinely throughout the process of care.

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Health and social service providers can begin to develop rapport during which step in the care relationship?

a. measuring pain

b. listing symptoms

c. self-reporting of pain and function

d. assessing of pain by health and social service provider

Correct! Self-report via the BPI allows people to individualize the assessment of both pain and function.

Incorrect. The correct answer is c. Self-report via the BPI allows people to individualize the assessment of both pain and function.

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Which of the following describes the application of clinical practice guidelines for the treatment of pain and/or OUD?

a. Guidelines are applied to develop an individualized plan of care for each person.

b. Guidelines can be applied prescriptively to each person.

c. The application of guidelines is determined by the health and social service provider.

d. Guidelines are used only as suggestions for the development of a plan of care by the health and social service provider.

Correct! Individualized plans of care, developed in collaboration with the person experiencing pain and/or OUD, have been shown to improve treatment outcomes

Incorrect. The correct answer is a. Individualized plans of care, developed in collaboration with the person experiencing pain and/or OUD, have been shown to improve treatment outcomes

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References