Journal of general internal medicine
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Randomized Controlled Trial
Brief report: Training internists in shared decision making about chronic opioid treatment for noncancer pain.
The use of chronic opioids for noncancer pain is an increasingly common and difficult problem in primary care. ⋯ Training primary care physicians in the shared decision-making model improves physician satisfaction in caring for patients with chronic pain and promotes the use of patient treatment agreements. Further research is necessary to determine whether this training improves patient satisfaction and outcomes.
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Medication decision making is complex, particularly for older patients with multiple conditions for whom benefits may be uncertain and health priorities may be variable. While patient input would seem important in the face of this uncertainty and variability, little is known about older patients' views of involvement in medication decision making. ⋯ While evolution to greater patient involvement in medication decision making may be possible, and desirable to some older patients, findings suggest that the transition will be challenging.
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Despite advances in treatment of diabetes, many barriers to good glycemic control remain. ⋯ Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.
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Given differences in cancer survival by race, black women may differ from white women in breast cancer risk perceptions. ⋯ Awareness of risk perceptions can help physicians to tailor patient education. Physician acknowledgment of more accurate risk perceptions among black women may serve as a basis to improve patient-physician communication.