Engagement in Prescription Opioid Tapering Research: the EMPOWER Study and a Coproduction Model of Success

Abstract

Patients with chronic pain experience stigma within the healthcare system. This stigma is compounded for those taking long-term prescription opioids. Often, public messaging and organizational policies have telegraphed that opioid treatment is a problem to be solved by focusing only on medication reduction efforts. Lack of data has contributed to misperceptions and poor opioid policies. In part, data collection remains poor because patients feel fractured from systems of care and are often not interested in engaging with opioid reduction mandates and research. Similarly, clinicians may fail to engage with opioid stewardship and research due to complexities that exceed their training or capacities. The EMPOWER study applies a coproduction model that engages researchers, patients, clinicians, managers, and other health system users. Key stakeholders shaped the design of the study to best ensure acceptability and engagement of the “end users”—patients who enroll in the study and the clinicians who implement the opioid tapers. Targeting the needs of any stakeholder group in isolation is suboptimal. Accordingly, we detail the EMPOWER patient-centered opioid tapering clinical research framework and specific strategies to address stakeholder concerns. We also discuss how this framework may be applied to enhance engagement in healthcare research broadly.

Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

“…We believe that endorsing patient control and agency during opioid taper is critical for optimal patient outcomes. 26 Currently, this individualized consensual approach is being extended to a large 4-state trial. 10 To encourage patient retention and improvement, weekly surveys are used to rapidly identify and address patient discomfort and distress, including pausing or stopping their taper or adding adjuvant medications.…”

Evaluating the Effectiveness of a Self-Management Program on Patients Living with Chronic Diseases

“…Nemours studies reported that individuals who acquire these self-management skills are able to take an active role in managing their condition and adopting a healthy lifestyle. 16 , 30 , 31 …”

“… 32 Recent evidence also suggests that action planning is considered one of the effective elements of the CDSMP for improving self-efficacy and the motivation for behavioral changes. 16 , 30 , 31 …”

Patient and Veteran Engagement in Health Research: the Emergence of a Field of Study

“…The perspectives and original research articles in this supplement share a focus on the lived experience of the participants of engagement, as well as exploring barriers and facilitators that can affect group cohesion. [5][6][7][8][9][10][11][12][13][14][15] Many of the studies measured satisfaction with the engagement process as a key outcome. One strong commonality amongst the perspectives and original research articles is the use of descriptive approaches, often outlining the temporal flow of the engagement process for a project and frequently accompanied by qualitative and/or mixed methods.…”