Screening for Breast Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Breast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear.

Objective: To review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force.

Development and Testing of a Communication Intervention to Improve Chronic Pain Management in Primary Care: A Pilot Randomized Clinical Trial.

Objectives: Effective communication skills are essential for optimally managing chronic pain and opioids. This exploratory, sequential mixed methods study tested the effect of a novel framework designed to improve pain-related communication and outcomes.

Methods: Study 1 developed a novel 5-step framework for helping primary care clinicians discuss chronic pain and opioids with patients.

Visit Linearity in Primary Care Visits for Patients with Chronic Pain on Long-term Opioid Therapy.

Background: Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration.

Objective: This study creates a novel measure, "visit linearity," to assess visit organization and examines whether visits that require less shifting back and forth between topics are associated with better patient and physician visit experiences.

Expanding the Scope of the Visit: Which Patient-Initiated Additional Concerns Receive Help?

This study examines patient-initiated additional concern presentations in general surgery visits to assess which factors contribute to them getting "helped." Concern presentations were analyzed for a variety of design features (e.g.

Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.

Background: Agenda setting is associated with more efficient care and better patient experience. This study develops a taxonomy of visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience.

Methods: This observational study analyzed 83 video recorded US primary care visits at a single academic medical center in California involving family medicine and internal medicine resident physicians (n = 49) and patients (n = 83) with chronic pain on opioids.

Making the most of video recorded clinical encounters: Optimizing impact and productivity through interdisciplinary teamwork.

Patient-clinician interactions are central to technical and interpersonal processes of medical care. Video recordings of these interactions provide a rich source of data and a stable record that allows for repeated viewing and analysis. Collecting video recordings requires navigating ethical and feasibility constraints; further, realizing the potential of video requires specialized research skills.

Communication about chronic pain and opioids in primary care: impact on patient and physician visit experience.

Patients and physicians report that communication about chronic pain and opioids is often challenging, but there is little empirical research on whether patient-physician communication about pain affects patient and physician visit experience. This study video recorded 86 primary care visits involving 49 physicians and 86 patients taking long-term opioids for chronic musculoskeletal pain, systematically coded all pain-related utterances during these visits using a custom-designed coding system, and administered previsit and postvisit questionnaires. Multiple regression was used to identify communication behaviors and patient characteristics associated with patients' ratings of their visit experience, physicians' ratings of visit difficulty, or both.

Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?

Objective: Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences.

Materials And Methods: Pre-visit and post-visit questionnaires for 87 primary care visits that involved patients taking opioids for chronic musculoskeletal pain and primary care resident physicians. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important.

Factors Associated with Opioid Dose Increases: A Chart Review of Patients' First Year on Long-Term Opioids.

Objective: To examine encounter-level factors associated with opioid dose increases during patients' first year on opioid therapy for chronic pain.

Design: Case-control study analyzing all opioid prescriptions for patients with chronic pain during their first year after opioid initiation. Cases were patients who experienced an overall dose escalation of ≥ 30 mg morphine equivalents over the 1-year period; controls did not experience overall dose escalation.

Potential antidepressant overtreatment associated with office use of brief depression symptom measures.

Background: Use of brief depression symptom measures for identifying or screening cases may help to address depression undertreatment, but whether it also leads to diagnosis and treatment of patients with few or no symptoms-a group unlikely to have major depression or benefit from antidepressants-is unknown. We examined the associations of use of a brief depression symptom measure with depression diagnosis and antidepressant recommendation and prescription among patients with few or no depression symptoms.

Methods: We conducted exploratory observational analyses of data from a randomized trial of depression engagement interventions conducted in primary care offices in California.