Phillip Summers, MD, MPH
University of California, Davis
“Improving Resident Empathy and Effectiveness in Caring for People Who Use Drugs”
SAEMF/RAMS Resident Research Grant
The goal of this project is to develop and demonstrate the effectiveness of an educational intervention to increase residents’ empathy and effectiveness in caring for people who use drugs (PWUD).
We hypothesize that residents participating in an oral history-based “empathy exercise” will demonstrate improved attitudes and knowledge and be more likely to offer screening and evidence-based interventions to patients at risk for substance use disorders (SUD) in their practice, compared to baseline data obtained prior to the empathy exercise. Training in the identification and management of SUD and their complications is sorely lacking in emergency medicine, even in the context of increasing opioid use in the general population. PWUD frequently require care in emergency departments (EDs) for issues such as overdoses and skin and soft tissue infections. Negative interactions with healthcare providers can create a “risk environment” of hospitalization, contributing to risk of leaving against medical advice or using illicit substances while hospitalized. There is prevalent stigma against PWUD among the general public and healthcare providers, and this can contribute to untherapeutic and detrimental relationships between providers and PWUD. Implementing medication assisted therapy such as buprenorphine can help with symptoms of withdrawal and pain acutely and can provide an efficient, cost-effective, and evidence-based bridge to outpatient opioid replacement therapy and addiction recovery, yet it is not commonly offered in most EDs.
This study will consist of a standard SUD education module plus an “empathy exercise”, which consists of a group-based guided discussion-style intervention. In this exercise, residents will conduct semi-structured interviews with key informants, who are community members with lived experience of drug use. This exercise will be piloted and refined prior to implementation. At time points pre-intervention, postintervention, and six-month follow-up, a custom survey instrument will be administered to both groups, containing a combination of validated survey tools and specific questions tested and refined through cognitive interviews with residents. Additionally, a chart review will monitor resident clinical behaviors, documentation, and engagement with concurrently implemented screening, diagnosis, decision aid, and treatment tools. Additionally, charts will be analyzed qualitatively to identify trends in stigmatizing language. The findings from this study can then be used as the foundation for a larger, randomized, multicenter trial to validate the intervention and demonstrate its effectiveness more definitively.
Dr. Summers is still completing the project.