Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Clark, M. R. (2011). Chronic opioid therapy for chronic pain: An e-learning program to develop shared decision-making and communication skills. Current Pain and Headache Reports, 15(2), 88-90. 
Sullivan, M. D., Gaster, B., Russo, J., Bowlby, L., Rocco, N., Sinex, N., et al. (2010). Randomized trial of Web-based training about opioid therapy for chronic pain. Clinical Journal of Pain, 26(6), 512-517.
Supplementary Materials Between-group knowledge quiz data, by residency year and gender [Table]
Guidelines for Negotiating a Patient Care Agreement for Chronic Non-Malignant Pain Management
Physician-Patient Pain Treatment Agreement--Follow-Up Version
Suchman, A. L., Roter, D., Green, M., Lipkin, M., Jr., & the Collaborative Study Group of the American Academy on Physician and Patient. (1993). Physician satisfaction with primary care office visits. Medical Care, 31(12), 1083-1092.
Sullivan, M. D., Leigh, J., & Gaster, B. (2006). Brief report: Training internists in shared decision making about chronic opioid treatment for noncancer pain. Journal of General Internal Medicine, 21(4), 360-362.
Outcomes
| Outcome 1: Knowledge of the role of opioids in chronic noncancer pain management |
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Description of Measures
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Knowledge of the role of opioids in the management of chronic noncancer pain in outpatients was assessed using a 9-item multiple-choice quiz. The measure was developed for the study and included the topics of opioid pharmacology, controlled substance regulations, and diagnostic challenges. Participants responded to each item (e.g., "The average percent pain relief for chronic non cancer pain achieved in randomized trials is approximately: a. 10%, b. 30% [correct answer], c. 50%, or d. 80%"); incorrect responses were scored as 0, and correct responses were scored as 1. Total scores ranged from 0 to 9, with higher scores indicating greater knowledge. Assessments occurred before training (baseline) and immediately after training (posttraining).
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Key Findings
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In a clinical trial, internal medicine residents from five residency programs were recruited by email and randomly assigned in blocks according to gender and year of residency to receive COPE or the Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. The VA/DoD guideline is a 26-chapter document, released in 2003, that uses a modular approach to provide key points and a treatment algorithm flowchart with recommendations for the use of opioids to treat outpatients who have chronic noncancer pain. From baseline to posttraining, internal medicine residents who received COPE had a greater increase in knowledge scores relative to internal medicine residents who received the VA/DoD guideline (5.9 to 8.4 vs. 5.7 to 6.1; p < .00001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.2
(0.0-4.0 scale)
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| Outcome 2: Competence in managing outpatients' chronic noncancer pain |
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Description of Measures
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Competence in managing outpatients' chronic noncancer pain, both in general and with the use of opioids, was assessed by two self-rated items developed for the study: "I feel competent in the overall management of outpatients with chronic non-cancer pain" and "I feel competent in the use of opioids for the management of outpatients with chronic non-cancer pain." Using a Likert scale ranging from 0 (not competent) to 10 (completely competent), respondents rated their perceived level of competence on each of the two items. Assessments occurred before training (baseline) and 45-60 days after training (follow-up).
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Key Findings
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In a clinical trial, internal medicine residents from five residency programs were recruited by email and randomly assigned in blocks according to gender and year of residency to receive COPE or the VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. The VA/DoD guideline is a 26-chapter document, released in 2003, that uses a modular approach to provide key points and a treatment algorithm flowchart with recommendations for the use of opioids to treat outpatients who have chronic noncancer pain. From baseline to follow-up, compared with internal medicine residents who received the VA/DoD guideline, internal medicine residents who received COPE had greater improvements in self-rated levels of competence in the general management of outpatients' chronic noncancer pain (3.2 to 3.7 vs. 3.1 to 3.5; p = .01) and in the use of opioids for managing chronic noncancer pain (3.2 to 3.8 vs. 3.2 to 3.5; p = .02).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.2
(0.0-4.0 scale)
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| Outcome 3: Satisfaction with recent encounters with patients experiencing chronic pain |
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Description of Measures
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Satisfaction with recent encounters (i.e., past 45-60 days) with patients experiencing chronic pain was assessed by a modified version of the 20-item Physician Satisfaction Questionnaire. The items cover six subscale domains of physician-patient interactions:
- General satisfaction (e.g., "This was a very satisfying visit for me")
- Adequately trained (e.g., "I felt adequately trained and confident in treating this patient")
- Quality of the patient-physician relationship (e.g., "I established effective rapport with this patient")
- Adequacy of the patient data collection process during the visit (e.g., "I didn't get all the detail I wanted on the patient's problem and symptoms")
- Appropriate use of office visit time (e.g., "My time was NOT well spent in the visit")
- Cooperative, nondemanding nature of the patient during the office visit (e.g., "This patient demands a lot of personal attention")
Using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree," respondents rated each item. Higher ratings across subscales indicate greater satisfaction. Assessments occurred before training (baseline) and 45-60 days after training (follow-up).
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Key Findings
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In a clinical trial, internal medicine residents from five residency programs were recruited by email and randomly assigned in blocks according to gender and year of residency to receive COPE or the VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. The VA/DoD guideline is a 26-chapter document, released in 2003, that uses a modular approach to provide key points and a treatment algorithm flowchart with recommendations for the use of opioids to treat outpatients who have chronic noncancer pain. From baseline to follow-up, compared with internal medicine residents who received the VA/DoD guideline, internal medicine residents who received COPE had greater improvements in self-rated levels of satisfaction on two subscale domains of the Physician Satisfaction Questionnaire: adequately trained (2.7 to 3.4 vs. 2.7 to 3.2; p = .03) and quality of the patient-physician relationship (12.1 to 13.1 vs. 12.2 to 12.5; p = .02).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.2
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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18-25 (Young adult)
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54.9% Male
45.1% Female
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Data not reported/available
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Knowledge of the role of opioids in chronic noncancer pain management
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1.5
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1.8
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1.5
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3.0
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2.5
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3.0
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2.2
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2: Competence in managing outpatients' chronic noncancer pain
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1.5
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1.5
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1.5
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3.0
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2.5
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3.0
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2.2
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3: Satisfaction with recent encounters with patients experiencing chronic pain
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1.5
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1.5
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1.5
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3.0
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2.5
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3.0
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2.2
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Study Strengths Intervention fidelity was strengthened by the online delivery format of the training course, and the online assessment of outcome measures provided for a systematic and unbiased data collection protocol. The inclusion of an active comparison condition and the use of random assignment by blocks according to gender and year of residency controlled for many potential confounding variables. Study participants who completed both assessments were compared with those who were missing one or both assessments. The investigators analyzed the data in two ways: first, statistical modeling was carried out only for study participants with complete outcome assessment data, and second, a more sophisticated statistical modeling was carried out with an intent-to-treat approach that analyzed data from all randomized participants (including those participants with missing outcome assessments).
Study Weaknesses There was no well-developed conceptual framework for the nine multiple-choice items that made up the knowledge outcome quiz, which compromised the reliability and validity of this study-created outcome measure. The self-rated competence outcome measure, also created for this study, consisted of only two items with no reliability or evidence of validity. There was no direct measurement of the intervention dosage received by each participant, such as time logged in to the training site or which of the six course chapters were accessed and in what order. The frequency of using the course while logged in and the attention given to the various course chapters varied by each participant and were uncontrolled by the investigators. There was a large amount of assessment data with one or both assessments missing across participants (33%).
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Readiness for Dissemination
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
COPE brochure
COPE online course, http://elearning.talariainc.com/default.aspx?pagekey=49581
Program Web site, http://www.cope-pain.org/
University of Washington School of Medicine's Continuing Medical Education Web site, http://depts.washington.edu/cme/online/course/EN0903
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.3
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2.5
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2.0
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2.6
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Dissemination Strengths The interactive course is thorough, detailed, and easy to navigate. The individual chapters within the course contain specific learning objectives. Videos depict realistic patient-physician interactions that demonstrate shared decisionmaking skills. The online nature of the course allows users to access it at their convenience. The University of Washington regularly monitors completion rates and participant feedback for use in ongoing course improvement.
Dissemination Weaknesses No summary of the course material is provided, and course-specific support materials for physician use are limited. It appears that the only technical assistance available during and after taking the course is via phone or email, with no structured consultation or supervision options available to strengthen fidelity to the intervention. Pre- and posttests of knowledge acquisition are available, but their use is not required for the successful completion of the course.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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COPE: Collaborative Opioid Prescribing Education (online course)
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Free
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Yes
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Phone and email technical assistance through the University of Washington School of Medicine's Office of Continuing Medical Education
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Free
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No
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Additional Information Physicians who seek written certification from an institution accredited by the Accreditation Council for Continuing Medical Education may apply for credit through the University of Washington School of Medicine's Office of Continuing Medical Education for a fee of $45. The University of Washington also designates the successful completion of COPE for a total of 3 American Medical Association Physician's Recognition Award Category 1 Credits.
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
* Sullivan, M. D., Gaster, B., Russo, J., Bowlby, L., Rocco, N., Sinex, N., et al. (2010). Randomized trial of Web-based training about opioid therapy for chronic pain. Clinical Journal of Pain, 26(6), 512-517.
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