Talk About It! Shared Decision-Making for Opioid Agonist Therapy Initiation: Effects on Patients

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) to increase and improve conversations with patients with opioid use disorder (OUD) about opioid agonist therapies (OAT, buprenorphine and methadone). The objective of this study was to evaluate the effects of TAI on patient-reported outcomes of choice awareness, SDM, and OAT initiation.

In a pilot trial, using a quasi-experimental design, we prospectively enrolled adult ED patients with OUD not currently on medications before and after TAI implementation (pre:4/24-10/24; post:6/25-11/25). Participants answered survey questions assessing 3 domains: the occurrence of a conversation about OAT, the extent of SDM (validated SDM-P scale, range 0-12), and OAT initiation (primary outcome). We used tests of proportions with 95% confidence intervals, and Mann Whitney U testing for skewed data.

During the study periods, of 444 patients screened, 76 were eligible and approached, and 48 consented to enrollment, (pre: 26, post: 22). Seventeen (35%) were women, and 31(65%) were white. Regarding conversation occurrence, the proportion reporting that their provider spoke to them increased from 7(27%) to 14(64%) (95%CI for difference: 10, 64%) for buprenorphine and 9(35%) to 16(73%) (95%CI for difference: 12, 64%) for methadone. SDM-P median scores increase from 1 to 5 (p=0.016). Buprenorphine initiation increased marginally, 1(4%) to 2(9%) (95%CI for difference: -9, 19%) and methadone initiation increased from 7(27%%) to 11(50%) (95%CI for difference: -1, 47%).

Though confidence intervals were large and crossed zero for change in OAT initiation, the preliminary data in this pilot study suggest TAI may have effects on patient care and OAT initiation.