Trial Outcomes & Findings for Improving Communication About Pain and Opioids (NCT NCT03629197)

Last Updated: 2026-07-27

Results Overview

Compare frequency of use of targeted communication behaviors observed per visit for residents in the Intervention vs Control arm (using coding of recorded visits to assess skill use). We first developed a list of targeted communication behaviors that were targeted by our intervention and based on our conceptual model. We developed a coding manual to count the number of unique behaviors in each study visit. We analyzed audio recordings and transcripts from all study visits to count the number of targeted behaviors per each visit. Multiple team members measured communication behaviors in each visit to ensure reliability of this measure.

Recruitment status

COMPLETED

Study phase

Target enrollment

95 participants

Primary outcome timeframe

Over a 3-9 month period (depending on how soon after the intervention clinicians' appointments with patient participants can be scheduled).

Results posted on

2026-07-27

Participant Flow

Clinician participant recruitment began in August 2018. Patient participant recruitment began in December 2018. Recruitment occurred at two academic primary care clinics at the University of California Davis Health.

Participant milestones

Participant milestones
Measure	Communication Skills Training Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient. Patient participants will be assigned to the arm of the study clinician they see for their study visit.	Control Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines. Patient participants will be assigned to the arm of the study clinician they see for their study visit.
Clinician Participants STARTED	24	23
Clinician Participants COMPLETED	24	21
Clinician Participants NOT COMPLETED	0	2
Patient Participants STARTED	26	22
Patient Participants COMPLETED	25	21
Patient Participants NOT COMPLETED	1	1

Reasons for withdrawal

Reasons for withdrawal
Measure	Communication Skills Training Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient. Patient participants will be assigned to the arm of the study clinician they see for their study visit.	Control Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines. Patient participants will be assigned to the arm of the study clinician they see for their study visit.
Clinician Participants Withdrawal by Subject	0	2
Patient Participants opioids not prescribed by primary care clinician	1	1

Baseline Characteristics

This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.

Baseline characteristics by cohort

PRIMARY outcome

Timeframe: Over a 3-9 month period (depending on how soon after the intervention clinicians' appointments with patient participants can be scheduled).

Population: primary care physicians

Outcome measures

Outcome measures
Measure	Communication Skills Training n=24 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=21 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Clinician Number of Targeted Behaviors Per Visit	3.5 # of targeted behaviors per visit Standard Deviation 2.8	2.8 # of targeted behaviors per visit Standard Deviation 2.4

PRIMARY outcome

Timeframe: 8 weeks

Population: This outcome includes patient participants only. Results are reported separately for the Communication Skills Training and Control arms; no arm/group data have been combined.

Brief Pain Inventory (BPI) Pain Interference subscale consists of 7 categories relating to how pain interferes with patients' lives. Patients are asked to rate their pain on a zero (Does Not Interfere) to 10 (Completely Interferes) scale. The 7 categories are: 1. General Activity, 2. Mood, 3. Walking Ability, 4. Work, 5. Relationships, 6. Sleep, 7. Enjoyment of life. Results are averaged to give an overall interference rating from 0-10, with higher scores indicating worse pain.

Outcome measures

Outcome measures
Measure	Communication Skills Training n=25 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=21 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Compare Efficacy of Control vs Intervention by Measuring Changes in the Way Pain Interfered With Patients Lives Using the Brief Pain Inventory - Pain Interference Subscale Survey	6.3 units on a scale Standard Deviation 2.8	5.8 units on a scale Standard Deviation 2.9

SECONDARY outcome

Timeframe: 8 weeks

Population: patients

Brief Pain Inventory (BPI) Short Form -- Pain Severity subscale has 4 survey questions / categories, asking patients to rate the severity of their pain on a 0-10 scale (with 0 being No Pain and 10 being Worst Possible Pain). The 4 Categories are, A. At it's worst in the last 24 hours, B. At it's best in the last 24 hours, C. Pain on average, D. Pain right now. Results are averaged to give an overall score (0-10) with higher scores indicating worse outcomes.

Outcome measures

Outcome measures
Measure	Communication Skills Training n=25 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=21 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Compare Efficacy of Control vs Intervention by Measuring Changes in the Severity of Patients Pain Using the Brief Pain Inventory - (Short Form) Pain Severity Subscale Which Measures the Severity of the Patient's Pain.	6.5 units on a scale Standard Deviation 2.3	6.0 units on a scale Standard Deviation 1.8

SECONDARY outcome

Timeframe: Over a 3-9 month period (depending on how soon after the intervention clinicians' appointments with patient participants can be scheduled).

Population: patient visits

Comparison of difficult doctor-patient encounter scale for Intervention vs Control physicians. Difficult doctor-patient relationship scale has 10 items scored from 1-6. The overall scale range is 10-60, with higher values indicating more difficult (worse) visits. Physicians complete this measure for each study patient.

Outcome measures

Outcome measures
Measure	Communication Skills Training n=21 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=16 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Difficult Doctor-Patient Relationship Questionnaire	25.8 units on a scale Standard Deviation 12.3	22.8 units on a scale Standard Deviation 7.0

SECONDARY outcome

Timeframe: 8 weeks

Population: patients

Patient experience score for patients who saw Intervention and Control physicians, measured by post visit patient agreement with treatment plan, patient trust, and patient assessment of clinician communication skills. Patient experience is a standardized composite average of three validated scales: Consumer Assessment of Healthcare Providers and Systems (CAHPS) Adult Visit Survey communication subscale, range 0 to 12, with higher scores indicating better communication. Patient Agreement with Treatment Plan Scale, range 3 to 21, with higher scores indicating greater agreement. Brief Wake Forest Physician Trust Scale, range 5 to 25, with higher scores indicating greater trust. The three scales were standardized and averaged into a single composite score. The theoretical composite score ranges from -4.5 to 0.6, with higher scores indicating a better patient experience. Results are reported separately for each study arm as mean (standard deviation).

Outcome measures

Outcome measures
Measure	Communication Skills Training n=25 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=21 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Patient Experience Score	-0.1 units on a scale Standard Deviation 1.1	0.1 units on a scale Standard Deviation 0.6

SECONDARY outcome

Timeframe: 1-3 months

Population: physicians who participated in / were randomized to the intervention group

Physician reported assessment of intervention. Investigators will ask for physicians' evaluation of the feasibility, acceptability, and utility of the intervention. Investigators will offer 10 value statements about the intervention. Physicians will select 1 from the following choices: strongly agree, agree, neutral, disagree, strongly disagree. Results will be reported as the percentage who agree or strongly agree with each statement.

Outcome measures

Outcome measures
Measure	Communication Skills Training n=21 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Physicians' Overall Appraisal of the Standardized Patient Intervention intervention quality	21 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention intervention helpful	21 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention intervention easy to understand	21 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention intervention relevant	21 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention intervention would lead to improved patient care	21 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention will use skills learned in intervention	21 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention intervention disrupted patient flow	2 Participants	—
Physicians' Overall Appraisal of the Standardized Patient Intervention standardized patients were realistic	17 Participants	—

SECONDARY outcome

Timeframe: Over 3-9 month period (depending on how soon after the intervention clinicians' appointments with patient participants can be scheduled).

Population: primary care physicians

Physician self-efficacy for communication skills for Intervention vs Control physicians. These questions ask about physicians' confidence related to managing chronic non-cancer pain in primary care. Physicians will be asked to rate how strongly they agree or disagree with 8 statements (each on 1-5 scale. Higher values indicate greater (better) self-efficacy. Baseline and post-visit ratings of self efficacy will be computed, and we will measure change in self efficacy (post-visit self efficacy minus baseline self efficacy) for Control vs Intervention physicians. Overall score range will be 1-5, with higher numbers indicating better self efficacy.

Outcome measures

Outcome measures
Measure	Communication Skills Training n=21 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=16 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
Physician Communication Self-efficacy	3.8 units on a scale Standard Deviation 0.6	3.4 units on a scale Standard Deviation 0.6

OTHER_PRE_SPECIFIED outcome

Timeframe: Over 3-9 month period (depending on how soon after the intervention clinicians' appointments with patient participants can be scheduled).

Population: patients

Prevalence of high-risk opioid prescribing as measured by chart review; defined either as being prescribed 90MME or more OR being prescribed opioids plus benzodiazepines 2 months after study completion based on chart review

Outcome measures

Outcome measures
Measure	Communication Skills Training n=25 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient	Control n=21 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines.
High-risk Opioid Prescribing	6 Participants	2 Participants

Adverse Events

Communication Skills Training

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Control

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Stephen G Henry

University of California Davis

Phone: 19167347005

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place

Measure	Communication Skills Training n=46 Participants Intervention clinicians will receive 2 standardized patient visits. The first visit will consist of an 8 minute video on the development of 5 key communication skills, a 10-12 minute role-play session to practice using these skills, and 8-10 minutes of constructive feedback. The 2nd visit will include only the role-play and feedback components. Clinicians will also get a printed pocket card and pamphlet explaining the targeted communication skills in more detail. Communication skills training: Intervention components include an 8-10 minute instructional video, a pocket card and pamphlet, and 2 standardized patient visits with role-play and feedback by the standardized patient. Patients will be assigned to the arm of the clinician they see for their study visit. Each study clinician can see up to 2 study patients.	Control n=37 Participants Control clinicians will receive a written summary of the 2016 CDC opioid prescribing guidelines, which include recommendations for best practices for use of opioids to treat chronic non-cancer pain. CDC guidelines will serve as an attention control. Attention control: Physician will review materials based on CDC opioid prescribing guidelines. Patients will be assigned to the arm of the clinician they see for their study visit. Each study clinician can see up to 2 study patients.	Total n=83 Participants Total of all reporting groups
Age, Continuous	29.8 years STANDARD_DEVIATION 2.6 • n=21 Participants • refers to clinician participants	29.5 years STANDARD_DEVIATION 2.6 • n=16 Participants • refers to clinician participants	29.6 years STANDARD_DEVIATION 2.6 • n=37 Participants • refers to clinician participants
Sex: Female, Male Female	18 Participants n=21 Participants • numbers refer to clinician participants	7 Participants n=16 Participants • numbers refer to clinician participants	25 Participants n=37 Participants • numbers refer to clinician participants
Sex: Female, Male Male	3 Participants n=21 Participants • numbers refer to clinician participants	9 Participants n=16 Participants • numbers refer to clinician participants	12 Participants n=37 Participants • numbers refer to clinician participants
Race/Ethnicity, Customized Black	0 Participants n=21 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	1 Participants n=16 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	1 Participants n=37 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.
Race/Ethnicity, Customized Non-Hispanic White	9 Participants n=21 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	5 Participants n=16 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	14 Participants n=37 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.
Race/Ethnicity, Customized Native American	0 Participants n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.	1 Participants n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.	1 Participants n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.
Race/Ethnicity, Customized Hispanic White	4 Participants n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.	2 Participants n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.	6 Participants n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.
Race/Ethnicity, Customized Multi-racial / other	3 Participants n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.	3 Participants n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.	6 Participants n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only the patient participants.
Race/Ethnicity, Customized Asian	8 Participants n=21 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	10 Participants n=16 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	18 Participants n=37 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.
Race/Ethnicity, Customized Multi-race / other	4 Participants n=21 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	0 Participants n=16 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	4 Participants n=37 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.
Brief Pain Index Interference	7.4 units on a scale STANDARD_DEVIATION 1.9 • n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	6.2 units on a scale STANDARD_DEVIATION 2.5 • n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	6.9 units on a scale STANDARD_DEVIATION 2.2 • n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
Brief Pain Index Intensity	7.3 units on a scale STANDARD_DEVIATION 1.8 • n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	6.4 units on a scale STANDARD_DEVIATION 1.8 • n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	6.9 units on a scale STANDARD_DEVIATION 1.8 • n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
VR-12 Mental component score	39.0 units on a scale STANDARD_DEVIATION 11.9 • n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	43.9 units on a scale STANDARD_DEVIATION 11.3 • n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	41.2 units on a scale STANDARD_DEVIATION 11.8 • n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
VR-12 Physical component score	24.3 units on a scale STANDARD_DEVIATION 7.8 • n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	24.0 units on a scale STANDARD_DEVIATION 7.7 • n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	24.2 units on a scale STANDARD_DEVIATION 7.7 • n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
PHQ-8	10.0 units on a scale STANDARD_DEVIATION 6.8 • n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	10.6 units on a scale STANDARD_DEVIATION 6.1 • n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	10.3 units on a scale STANDARD_DEVIATION 6.4 • n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
GAD-7	9.6 units on a scale STANDARD_DEVIATION 6.4 • n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	8.0 units on a scale STANDARD_DEVIATION 5.0 • n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	8.9 units on a scale STANDARD_DEVIATION 5.8 • n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
Prescribed opioid daily dose (MME)	30 milligram morphine equivalents n=25 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	21.7 milligram morphine equivalents n=21 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.	30 milligram morphine equivalents n=46 Participants • This measure includes patient participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only patient participants.
Self-efficacy for chronic pain management	2.8 units on a scale STANDARD_DEVIATION 0.5 • n=21 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	2.9 units on a scale STANDARD_DEVIATION 0.4 • n=16 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.	2.9 units on a scale STANDARD_DEVIATION 0.5 • n=37 Participants • This measure includes clinician participants only. The Overall Number of Baseline Participants includes both patient participants (Communication Skills Training=25, Control=21, Total=46) and clinician participants (Communication Skills Training=21, Control=16, Total=37). Therefore, the Number Analyzed for this measure reflects only clinician participants.