A mixed methods study of patient–provider communication about opioid analgesics

•Pain management discussions are common in outpatient HIV encounters.•Providers may regard patients less favorably if opioids are discussed.•These conversations were sometimes adversarial.•Empathy may facilitate more productive discussions.

ObjectiveTo describe patient–provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients.MethodsWe audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers’ attitudes toward patients.Results48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n = 28, 58%) and ended by the providers (n = 36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n = 13) of encounters, no decision was made. Fewer than half of providers (n = 20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR = 0.51, 95% CI: 0.27–0.95) when opioids were discussed.ConclusionsPain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients.Practice implicationsEmpathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management.