A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm

Objectives People who self-harm frequently present to the emergency department (ED) and are treated by generalist healthcare staff with no specialist mental health training. We systematically reviewed (i) training interventions for generalist ED providers and (ii) psychosocial interventions delivered predominantly by generalist ED providers for people who self-harm. Method Five databases were searched for studies reporting on training interventions for generalist ED staff (at least 50% of the sample needed to be generalist ED staff) or psychosocial interventions for people who self-harm delivered predominantly by generalist ED staff. No limitations were placed regarding study design/country. Narrative synthesis was conducted. Results Fifteen studies from high-income countries were included. Nine studies of moderate methodological quality evaluated training for generalist ED providers (n = 1587). Six studies of good methodological quality evaluated psychosocial interventions for adults who self-harm (n = 3133). Only one randomized controlled trial was identified. Training was linked with pre-post improvements in staff knowledge, and less consistently with improvement in skills, attitudes, and confidence. Evidence on patient outcomes was lacking. Patient-level interventions involving common suicide prevention strategies—safety planning and follow-up contact—were consistently linked to pre-post reductions in suicide attempts. Effects on treatment engagement and psychiatric admissions were unclear. Conclusions There is a clear need for further RCTs to improve the evidence base for ED generalist providers managing patients with self-harm. Evidence supports potential benefits of training for improving staff knowledge, attitudes, and skills, and of safety planning and follow-up contact for reducing repeat suicide attempts. • More RCTs are needed to improve the evidence base for ED providers managing self-harm • Safety planning and follow up contacts are linked to reductions in repeat suicide attempts • Future research should investigate the impact of staff training on patient outcome

Feasibility and Acceptability of the Pain Profile, a Clinical Questionnaire Aimed at Improving Pain Care

Aleksandra Zarska,1 Stephanie Slat,1 Adrianne Kehne,1,2 Colin Macleod,1 Heather Rye,3 Cheryl Dehmlow,4 Paul Hilliard,5 Kaitlyn Jaffe,6 Pooja Lagisetty1,2 1Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; 2Center for Clinical Management and Research, Ann Arbor Veterans Health Administration, Ann Arbor, MI, USA; 3University of Michigan Medical Group Care Management – Complex Care Management, University of Michigan, Ann Arbor, MI, USA; 4Health Information Technology & Services, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; 5Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; 6Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USACorrespondence: Aleksandra Zarska, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Floor 4, Ann Arbor, MI, 48109, USA, Tel +17186109960, Email [email protected]: Despite being one of the most common medical complaints, chronic pain is difficult to manage due to ineffective communication between providers and patients and time restraints during appointments. Patient-centered questionnaires have the potential to optimize communication by assessing a patient’s pain history, prior treatments, and associated comorbidities to develop an effective treatment plan. This study aimed to analyze the feasibility and acceptability of a pre-visit clinical questionnaire aimed at improving communication and pain care.Patients and Methods: The “Pain Profile” questionnaire was piloted across two specialty pain clinics in a large academic medical center. Patient and provider surveys were conducted with patients who completed the Pain Profile questionnaire and providers who use it in practice. Surveys consisted of multiple-choice and open-ended questions regarding the helpfulness, usability, and implementation of the questionnaire. Descriptive analyses of patient and provider surveys were conducted. Qualitative data were analyzed using matrix framework-based coding.Results: A total of 171 patients and 32 clinical providers completed the feasibility and acceptability surveys. 77% of patients (N= 131) found the Pain Profile helpful in communicating their pain experiences and 69% of providers (N= 22) found it helpful in guiding clinical decisions. The section that assessed the impact of pain was rated most helpful by patients (4/5) while the open-ended section asking patients to describe their pain history was rated least helpful by patients and providers (3.7/5 and 4.1/5, respectively). Both patients and providers provided suggestions to future iterations of the Pain Profile, including the addition of opioid risk and mental health screening tools.Conclusion: The Pain Profile questionnaire was feasible and acceptable in a pilot study at a large academic site. Future testing in a large-scale, fully powered trial is needed to assess the effectiveness of the Pain Profile in optimizing communication and pain management.Keywords: chronic pain, communication, clinical questionnaire, pain management, outpatient car