It often starts in the doctor’s office or the emergency room. A patient has broken their leg and will be in pain for weeks. Another patient has had back surgery and is on their way home, but it will take time before they’re fully recovered. A third patient has returned for a consult about the constant pain that keeps them awake at night.
All of these patients could be prescribed opioids. But as the addiction crisis rages on, healthcare professionals have become wary of doling out addictive painkillers. Research has shown that the slippery slope of addiction often begins with a perfectly legal prescription.
That leaves doctors and nurses in a tricky position – they have patients in pain, but they harbor deep concerns about contributing to a problem that kills 91 people every day. Talking to patients about healthy ways to manage their pain, or convincing them that opioids aren’t the way to go, can be uncomfortable.
That’s where practice makes perfect, according to Cyrille Adam, the senior director for health programs at Kognito. The company has created virtual characters that help prepare healthcare professionals, teachers and others to have difficult conversations about addiction and substance abuse.
“Our goal is to harness the power of conversations with virtual humans to improve health,” he told Drug Delivery Business News.
“We are relying more and more on primary care professionals to identify people who are overusing or misusing opioids and provide them with treatment. It’s become essential that we have convenient and engaging tools to help providers learn how to navigate these conversations with patients.”
The company’s virtual simulations feature characters that are coded to display certain personalities and even different levels of realism, depending on the audience. Kognito recruits a panel of subject matter experts for each simulation, who are charged with reviewing the simulation’s content at every stage of development.
The primary care simulation, which is designed to help primary care physicians identify and assist people who are misusing opioids, has been recognized by the federal government and is listed in the National Registry of Evidence-based Programs and Practices – a program which was recently ended by President Donald Trump’s administration.
In medical school, students usually practice having hard discussions with actors that are hired to play patients. But Adam argued that this technique is uncomfortable for students who are afraid to say the wrong thing.
“This simulation technology really gives students and professionals, a very convenient tool. It’s online. It’s accessible from your own computer 24/7. It gives you the opportunity to interact with very a realistic character that is representative of your patient. It will give you very detailed, instructive feedback as opposed to doing role play with a classmate where you’re very tense and somebody is observing you and you’re very focused on saying the wrong thing,” he explained.
The technology also provides users with personalized results at the end of the simulation, giving the user a sense of how well they managed the conversation and how they could improve.
In one of the scenarios included in the primary care program, the user talks to a war veteran who comes to the doctor’s office for the first time complaining of chronic back pain. The virtual character explains that his previous doctor gave him Percocet, an opioid pain medication, and that it worked perfectly. He is looking for a refill.
“Now in the old days, there would have been no problem. Even a few years ago, any professional would have likely given that prescription,” Adam said. “Now, I think there’s greater awareness of the addiction risk associated with those medications.”
In this simulation, the user has to figure out how to tell a patient, who may already be addicted to the medication, that they can’t give them anymore of it. They have to help the patient identify better pain-relief options, while guiding them away from the one that could kill them.
“That’s a conversation that is extremely difficult for your average family physician or nurse,” Adam said.
But by using the simulation, the user can learn through trial and error – by practicing different responses and watching the patient’s reaction.
“It’s kind of like learning to ride a bicycle. You couldn’t do that by watching a Youtube video or looking at a PowerPoint presentation. You need to actually get on the bicycle and find your balance. Maybe fall a few times. You have help from training wheels and you have a parent helping you out,” he explained.
“We have similar support in the simulation, but the key really is that you get to actually practice these conversations, which is going to make you more skilled and give you confidence to navigate them in real life.”
Research has shown that after three months of using Kognito’s primary care simulation, more than half of practitioners reported an increase in screening and identifying patients with substance abuse disorders and more of them are having discussions about appropriate treatment options.
“What we’re trying to do is destigmatize these conversations about substance abuse,” Adam said.
“The style of communication that healthcare professionals employ is going to be absolutely crucial in those conversations where you have an opportunity to identify and influence a patient who may be going down a path of an addiction to an opioid pain medication, which may eventually lead to a heroin addiction and an overdose.”
Kognito is also working to bring its technology to more than 75 schools of health professions, including medical schools, nursing schools, schools of social work and dentistry.
“It is absolutely crucial to train the future generation of professionals to have better practice standards around the prescribing of drugs and addressing substance abuse disorders with their patients,” Adam said.
“We need to have a multi-pronged approach where we trained future health professionals, but we also train communities. Not just the professionals that patients are going to see when they already have a health issue, but there’s also a lot of work to do with other populations, for example, teachers and the role they play in discouraging substance abuse among students and identifying when there is problematic abuse or behavior among students.”