The Practitioner Proposes a Treatment Change and the Patient Declines: What to do next?

Paul R. Falzer, Howard L. Leventhal, Ellen Peters, Terri R. Fried, Robert Kerns, Marion Michalski, Liana Fraenkel

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: This study describes how pain practitioners can elicit the beliefs that are responsible for patients' judgments against considering a treatment change and activate collaborative decision making. Methods: Beliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about the significance of pain on the patient's life. The items were aggregated into 4 decision models that predict which patients are actually considering a change in their current treatment. Results: While only 34% of study participants were considering a treatment change overall, the percentage ranged from 20 to 70, depending on their ratings about current consequences of pain, emotional influence, and long-term impact. Generalized linear model analysis confirmed that a simple additive model of these 3 beliefs is the best predictor. Conclusion: Initial opposition to a treatment change is a conditional judgment and subject to change as specific beliefs become incompatible with patients' current conditions. These beliefs can be elicited through dialog by asking 3 questions.

Original languageEnglish (US)
Pages (from-to)215-226
Number of pages12
JournalPain Practice
Issue number3
StatePublished - Mar 2013

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine


  • Chronic illness
  • Naturalistic decision making
  • Pain
  • Pain management
  • Patient perception of illness
  • Patient-centered care
  • Patient-centered communication
  • Shared decision making


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