"Talk About It!" Shared Decision-Making for Methadone and Buprenorphine Initiation: Development and Preliminary...

Although robust evidence exists supporting opioid agonist treatment (OAT) as the best currently available treatment for opioid use disorder (OUD), many barriers prevent widespread access to the two most efficacious forms of OAT, buprenorphine and methadone. We sought to address interpersonal and knowledge-related barriers to OAT implementation by facilitating shared decision-making in the context of ED care. The objective of this study was to refine and evaluate an OUD treatment conversation aid in partnership with people with lived experience (PWLE).

We combined community-based participatory research principles, decision aid development guidelines, and qualitative methods. Via the longitudinal involvement of a multi-stakeholder Steering Committee (SC), interviews, and focus groups, we iteratively refined and evaluated a conversation aid, Talk About It (TAI). We performed beta-testing with ED patients with untreated OUD and clinicians and evaluated the aid via validated implementation measures of acceptability, appropriateness, and feasibility (3 scales, 4 questions each, range 1-5). Finally, TAI was translated into Spanish and Spanish-speaking patients and clinicians gave feedback.

Over 100 people engaged in the refinement and evaluation of TAI. Of the 75 patient and community member participants, about half (34) reported using opioids within the past week. Refinements to TAI included changing content, simplifying language, and adding quotes, faces, and local resources. Validated acceptability, appropriateness, and feasibility measures demonstrated increasing scores. ED patients with untreated OUD gave the final version mean scores of 4.72, 4.70, and 4.67, respectively (range 1-5), indicating high agreement with implementation potential.

TAI's content and style were designed, refined, and approved by PWLE, ED clinicians, and addiction experts. Further testing will be needed to measure effectiveness.