Randomized trial of web-based training about opioid therapy for chronic pain

Objectives: The treatment of chronic noncancer pain with chronic opioid therapy has increased rapidly, but medicine residents receive little training concerning this therapy. Therefore we conducted a trial to determine if an interactive web-based training focusing on shared decision-making for chronic opioid therapy improves knowledge and competence compared with exposure to practice guidelines. Methods: A randomized controlled educational trial of 213 internal medicine residents from 5 medicine residencies participating in the Residency Review Committee for Internal Medicine's Educational Innovations Project comparing access to interactive web-based training (COPE: Collaborative Opioid Prescribing Education) or access to the Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. Pretraining and immediate posttraining knowledge test; pretraining and 60-day posttraining self-reported competence, satisfaction, patient-centeredness, and selected clinical behaviors were analyzed using t tests, Pearson x², and Generalized Estimating Equations. Results: The web training group had greater increase in knowledge with training (x ²=72.06, P<0.00001) and greater self-rated competence in the management of outpatients with chronic pain (x²=6.48, P=0.01), and specifically in the use of opioids in this management (x²=5.17, P=0.02). Residents in both groups reported more satisfaction with managing chronic pain care after training (x²=52.72, P<0.0001), though the web training was superior on subscales concerning training adequacy (x ²=4.94, P=0.026) and relationship quality (x²=5.79, P=0.016). CONCLUSIONS: Exposure to an interactive web-based training focused on shared decision-making and communication skills was more effective than exposure to compatible practice guidelines for knowledge and self-reported competence in the management of chronic noncancer pain.