# Extending care beyond the clinic: integrating patient-reported outcomes in chronic pain management through human factors engineering

## TL;DR

This paper describes the development of a user-friendly app to help manage chronic pain and opioid tapering by involving patients and clinicians in the design process.

## Contribution

The novel contribution is the integration of human factors engineering and user-centered design to create a dual-facing app for chronic pain management and opioid tapering.

## Key findings

- The TAPR-CPM app was developed with five sections for providers and three for patients based on stakeholder input.
- Engaging diverse stakeholders was critical for creating a user-friendly app that supports patient engagement and clinical decision-making.
- Human factors methodologies and UCD approaches were successfully applied to translate evidence-based guidelines into a practical tool.

## Abstract

Tapering prescription opioid pain medication through evidence-based guidelines can help in combating the opioid epidemic. Integrating clinical decision support (CDS) into the clinical workflow of tapering can help in translating guidelines to formulate and implement a tapering plan that manages pain symptoms while minimizing withdrawal, and optimally engages with the patient. The purpose of our project was to develop patient- and clinician-facing CDS in the area of chronic pain management in one integrated application (app) called Tapering And Patient Reporting outcomes for Chronic Pain Management (TAPR-CPM) App.

We leveraged human factors methodologies and a user-centered design (UCD) approach through guideline review, stakeholder interviews, ethnographic workflow analysis, process mapping, design workshops, and usability testing. Participants included patients with chronic noncancer pain, their family members, pain management physicians, primary care physicians, and health IT developers who focus on patient- and provider-facing technologies.

Based on interview findings and workflow analysis, the provider-facing app had five sections: Patient Context, Taper Settings, Create Taper Plan, Withdrawal and Non-opioid Pain Plan, and Summary Dashboard. The patient-facing app had three sections: Maintaining a Pain Journal, Sharing Pain Scores with Provider, and Connecting to Resources about Opioid Tapering.

This project leveraged a multi-method approach based in human factors and UCD to develop the TAPR-CPM app. Engaging with a diverse set of stakeholders including patients, caregivers, primary care providers, pain specialists, and health information technology developers was critical to develop a user-friendly experience with accessible technology to support patient engagement and provider decision-making.