Transcript Preparing Professional Publications

Family History Information Helps
Inform Chronic Pain Treatment
Elizabeth Pestka, MS, PMHCNS-BC, APNG
Emily Dresher, MSN, RN
Joan Cronin, MS, PMHCNS-BC-LADC
Susan King, BSN, RN
Jacqueline Kimondo, BSN, RN
Cynthia Townsend, PhD, LP
Karen Weiss, PhD, LP
Susan Bee, MS, PMHCNS-BC
Virginia Nash, DNP, PMHCNS-BC
Michele Evans, MS, PMHCNS-BC
Mayo Clinic, Rochester, MN
©2012 MFMER | slide-1
Objectives
• Identify the prevalence of a family history of
substance abuse in patients admitted to the
Mayo Clinic Pain Rehabilitation Center
• Describe relationships between having a
positive family history of substance abuse and
patients’ understanding of their own risk
associated with family history
• Discuss nursing implications of assessing and
utilizing family history information in chronic
pain treatment
©2012 MFMER | slide-2
Background for Quality Improvement Study
• US Centers for Disease Control and
Prevention have classified prescription
drug misuse as an epidemic
• Chronic pain patients often have risk
factors for prescription drug addiction and
other substance use disorders
• Positive family history of substance abuse
is an identified risk factor
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Heritability of Substance Use Disorders
• Evidence from twin and adoption studies report
heritability of alcohol use disorders at 0.5 to 0.6
• Estimates for other substance use disorders
ranges from 0.3 to 0.8
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Benefits of Family History Information
• Identify persons who are at risk for
addiction in the future
• Identify persons who already have the
condition but have not been diagnosed or
treated
• Individualize interventions for each person
based on their family history
©2012 MFMER | slide-5
Aim of Quality Improvement Study
• Strengthen clinical practice by identifying the
prevalence of a family history of substance
abuse in the patient populations admitted to the
adult and pediatric Pain Rehabilitation Center
programs at Mayo Clinic and help guide
individualized treatment interventions for
persons with chronic pain and a family history
of a substance use disorder.
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Study Population and Sample
• Population includes patients seeking treatment
for chronic pain conditions at the Mayo Clinic
Pain Rehabilitation Center in Rochester, MN
between May 21, 2012 and August 10, 2012
• Sample is all persons voluntarily responding to
family history questions
• Consists of 94 adult patients
• Consists of 37 pediatric patients
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Study Methods
• Patients asked to report on a family history of
substance abuse disorders as part of their
admission assessment
• Findings documented in their electronic medical
record
• Patients asked to complete a very brief survey
questionnaire at the time of admission and at
dismissal from the 3 week programs
• Names used to connect family history data with
survey responses and then eliminated
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Study Survey : Patients Rated Their
Response from 1 – 5 on Three Questions
1. A family history of substance abuse increases
the risk of this condition in other family
members
2. Prescribed pain medications used by chronic
pain patients may be used as a substance of
abuse
3. There is benefit in education on substance
abuse in a pain rehabilitation program
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Data Analyisis
• Reported family history of a substance abuse
disorder extracted from patient records with
family relationship identified
• Family history data entered into an excel
spreadsheet
• Survey responses, pre and post treatment,
entered into the excel spreadsheet
• Descriptive results calculated
• Comparative results analyzed using SPSS
©2012 MFMER | slide-10
Reported Prevalence of a Family History of
Substance Abuse
• All patients (n=131)
• Adult patients(n=94)
• Pediatric patients
(n= 37)
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Reported Number of Affected Family
Members
• All patients
• Adult patients
• Pediatric patients
• Represents # of family
members reported
with substance abuse
in positive histories
©2012 MFMER | slide-12
Pre-Survey Question on Inherited Risk
• A family history of
substance abuse
increases the risk of
this condition in other
family members (rate
1 strongly disagree –
5 strongly agree)
• Mean all rating
• Mean adult rating
• Mean pediatric rating
©2012 MFMER | slide-13
Pre-Survey Question on Medication Abuse
• Prescribed pain
medication used by
chronic pain patients
may be used as a
substance of abuse
(rate 1 strongly
disagree – 5 strongly
agree)
• Mean all rating
• Mean adult rating
• Mean pediatric rating
©2012 MFMER | slide-14
Pre-Survey Question on Benefit of
Education
• There is benefit in
education on
substance abuse in a
pain rehabilitation
program (rate 1
strongly disagree – 5
strongly agree)
• Mean all patients
• Mean adult rating
• Mean pediatric rating
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Response Comparative Analysis
• Final data analysis is in process and will be
available for presentation and discussion at the
time of the conference
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Adult Chronic Pain Track on Awareness of
Substance Abuse
• Education and awareness related to substance
use disorders included for patients
• Family history important risk factor for
substance use disorders in chronic pain
patients
• Group time spent on diagramming family
pedigrees and discussing family histories of
substance use disorders and their implications
for each patient
©2012 MFMER | slide-17
Informing Chronic Pain Treatment
• Individualized patient education
• Specific counseling related to family history
• Motivational interviewing using a family history
of a substance use disorder as a factor to
support positive changes
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Pediatric Chronic Pain Consideration of
Risk for Substance Abuse
• Family history and personal use patterns are
used to determine need for an appointment
with a chemical dependency counselor for
further evaluation and possible treatment
recommendations
• Parent’s concerns are included in treatment
planning
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Examples of Individualized Treatment
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Potential of Individualized Medicine
Make health
care not only
more effective,
but more
efficient and
affordable
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Roles for Nurses in Individualized Care
• Clinical care focused
on health promotion
and disease
prevention
• Needs of each patient
and their family
members comes first
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Model regarding use of family history information in health promotion
Health professional
decision-making
regarding health
promotion/disease
prevention
strategies for family
members influenced
Family history
identifies inheritance
patterns and family
health risks
Likelihood of family
member engaging in
health
promoting/disease
preventing activity
improved
Likelihood of nurses
engaging in practice
of collecting
comprehensive
family history data
enhanced
Identification of most
relevant perceived
benefits to family
member health
promoting/disease
prevention action
strengthened
©2012 MFMER | slide-23
Summary
• Findings from this study provide data on
prevalence of a family history of substance abuse
in a population of chronic pain patients and
reports attitudes about family history information
• Examples of how family history information related
to substance abuse can support and tailor
treatment for chronic pain conditions including
education, counseling and motivational
interviewing
• Nurses can help maximize the potential of
individualized medicine
©2012 MFMER | slide-24