Shared Decision-Making in the Selection of Outpatient Analgesics for Older Individuals in the Emergency Department

Authors


Address correspondence to Timothy F. Platts-Mills, MD, 101 Manning Drive CB #7010, Medical School Wing C Basement, Anesthesiology Research, Chapel Hill, NC 27599. E-mail: tplattsm@med.unc.edu

Abstract

Objectives

To assess the relationship between older adults' perceptions of shared decision-making in the selection of an analgesic to take at home for acute musculoskeletal pain and (1) patient satisfaction with the analgesic and (2) changes in pain scores at 1 week.

Design

Cross-sectional study.

Setting

Single academic emergency department.

Participants

Individuals aged 65 and older with acute musculoskeletal pain.

Measurements

Two components of shared decision-making were assessed: information provided to the patient about the medication choice and patient participation in the selection of the analgesic. Optimal satisfaction with the analgesic was defined as being “a lot” satisfied. Pain scores were assessed in the ED and at 1 week using a 0-to-10 scale.

Results

Of 159 individuals reached by telephone, 111 met all eligibility criteria and completed the survey. Fifty-two percent of participants reported receiving information about pain medication options, and 31% reported participating in analgesic selection. Participants who received information were more likely to report optimal satisfaction with the pain medication than those who did not (67% vs 34%; P < .001). Participants who participated in the decision were also more likely to report optimal satisfaction with the analgesic (71% vs 43%; P = .008) and had a greater average decrease in pain score (4.1 vs 2.9; P = .05). After adjusting for measured confounders, participants who reported receiving information remained more likely to report optimal satisfaction with the analgesic (63% vs 38%; P = .04).

Conclusion

Shared decision-making in analgesic selection for older adults with acute musculoskeletal pain may improve outcomes.

Ancillary