Discussing Sensitive Topics with Injured Workers. Part 1

Linda Van Dillen, RN, BA, CCM; Twitter @CompAllianceRN; VP Communications & Chief Quality Officer, CompAlliance

When I give a presentation on opioids, my opening slide is a prayer card from a girlfriend’s son after he overdosed on heroin. I explain addiction affects every family in some way. I see universal nods as I look around the room.

I close my talk with a summary of the concept of discussing sensitive topics. There is never enough time to delve too deeply into this topic, but I do let the audience know it can be a very effective tool to obtain an honest and accurate biopsychosocial, drug and alcohol usage history from the injured worker. Obtaining an honest and accurate history is difficult due to many reasons. One is our reluctance to discuss these issues.

What keeps us claims and healthcare professionals from discussing these sensitive topics with our injured workers? There is a definite need to learn communication techniques that decrease your, the patient’s and other stakeholder’s anxiety and increase the accuracy and specificity of patient self-report about sensitive topics and basic screening protocols for assessing drug/alcohol use and concerns. We need to focus on the ‘how’ of asking, rather than the ‘what’ to ask.

What keeps us from discussing these sensitive topics with our injured workers?

• Our own anxiety to talk about certain sensitive topics.
  
• The patient’s anxiety to talk about these topics.
• The “how” of asking these questions – wording, order and form.

Here are two tools to assist in screening patients for alcohol or drug use:

CAGE-AID Screening Tool (can substitute drug use for alcohol or ask for both)

• Have you ever felt you should Cut down on your drug use?
  
• Have people Annoyed you by criticizing your drug use?
• Have you ever felt bad or Guilty about your drug use?
• Have you ever used a drug first thing in the morning to steady your nerves? (Eye-Opener) OR…

Two-Item Conjoint Dependency Screen (TICS) Adapted from American Board of Family Medicine

• Have you ever drunk or used more drugs than you meant to? (Yes or No)
  
• Have you ever felt you needed to cut down on your drinking or drug use over the last year? (Yes or No)

One helpful strategy is to ask the patient about his/her perspectives and observations about their use and consequences. Helpful questions include the following:

• Do you ever think you use too much?
  
• Have you ever tried to cut down on your use?
• Have you needed to use more to get the same effect?
• Has use created any problems, e.g. medical, educational, job?

In my next post, I will share a three-step communication technique used to decrease anxiety, increase accuracy, and a case study illustrating a conversation with Mr. S., an injured worker positive for both street drugs and alcohol on a post-accident drug screen.