Infectious complications of opioid use disorder (OUD) have increased significantly in the last decade. Patients with OUD encounter stigma from healthcare providers, and providers find interactions with patients with OUD to be very challenging. At our teaching institution, anecdotal experience and objective data suggested clinician discomfort with communicating with OUD patients, as well as a ‘hidden curriculum’ of stigma and bias around care of this group. We attempted to characterize this problematic learning environment and created an intervention focusing on reduction of bias and stigma and improved communication with OUD patients.
General internal medicine faculty and residents completed a pre-intervention survey to measure knowledge and attitudes about OUD, as well the institutional learning environment related to this issue. A workshop on communication, bias and stigma in OUD was then administered to 78 faculty and residents. Immediately after participation, they completed a post-intervention survey assessing concepts addressed in the session.
The pre-intervention survey of 99 faculty and residents showed that 47% felt patients with OUD were difficult to work with. Faculty were more likely than residents to agree there was a negative hidden curriculum around OUD (70% vs 43%, p<0.001). This included witnessing other physicians using stigmatizing language (80%), minimizing time with OUD patients (49%) and choosing not to involve medical students with OUD patients (34%). Fifty participants completed the post-survey. Respondents identified a mean of 86% of stigmatizing words within patient scenarios, which improved from 60% before the intervention (p<0.0001).
Clinicians reported negative attitudes and difficulty caring for patients with OUD. The majority identified a negative hidden curriculum around this disease, including stigmatizing language and avoidance of engagement with OUD patients. A workshop on communication, stigma and bias improved scores on knowledge of stigmatizing language.
C. F. Rowley, None