Talk About It! A Shared Decision-Making–Based Implementation Strategy for Opioid Agonist Therapy Initiation: Effects on Clinicians

Opioid agonist therapies (OAT), buprenorphine and methadone, are efficacious options for reducing mortality in patients with opioid use disorder (OUD). We developed and piloted a novel shared decision-making (SDM) based implementation strategy called Talk About It! (TAI) consisting of education and a conversation aid (CA). The objective of this study was to evaluate the effects of TAI on clinician-reported knowledge, behaviors and patient care.

In a pilot trial, we implemented TAI at one site and 3 sites served as controls (UC: usual care). We assessed clinician responses to TAI using a pre-post, difference-in-difference approach. The primary outcome was self-report of OAT initiation, and secondary outcomes included knowledge related to OAT initiation and report of conversations around OAT initiation.

At the TAI site, 45 clinicians completed the pre survey and 47 completed the post-survey. At the control sites, 36 completed the pre survey and 32 completed the post survey (78%pre-,76%post- response rates). Respondents were attending physicians (75%) and APPs (25%). The proportion who noted they had ‘started a patient on methadone in the past 12 mo.’ rose from 44% to 66% (+22%) in the TAI group and 22% to 31% (+9%) in the UC group. Self-report of buprenorphine initiation in the past 12 mo rose from 60% to 62% (+2%) at in the TAI group and 53% to 63%(+10%) in the UC group. For knowledge questions (ex “I am legally allowed to start a patient on methadone/buprenorphine”) and behavior questions (ex “I have had a conversations…”) increases were seen from pre-post in both TAI and UC groups and changes were larger for TAI clinicians, despite higher a higher baseline. Increases were also larger for methadone as compared to buprenorphine.

Preliminary data suggest TAI had effects on clinicians’ knowledge and behavior around OAT initiation, with larger effects regarding methadone.