“I Prefer to Stay Away”: A Qualitative Study of Patients in an Opioid-Sparing Pain Management Protocol

Abstract

Objective: The aim of this study was to explore beliefs and behaviors of opioid pain medications among patients undergoing elective surgery. Background: Opioid dependence after surgery is a major contributor to the ongoing opioid epidemic. Recent efforts by surgeons and health systems have sought to improve the education patients receive regarding safe opioid use after surgery; however, little is known about patients’ pre-existing beliefs surrounding opioids. Methods: Semistructured interviews were conducted with patients who underwent 1 of 4 common elective surgical procedures at 1 institution. Patients were specifically asked about their knowledge and beliefs about opioids before surgery and their opinions of opioid-sparing recovery after surgery. Coding was conducted through iterative steps, beginning with an initial cycle of rapid analysis, followed by focused coding, and thematic analysis. Results: Twenty-one patients were interviewed. Three major themes emerged regarding patient opinions about using opioids after surgery. First, there was widespread awareness among patients about opioid medications, and preoperatively, patients had specific intentions about using opioids, often informed by this awareness. Second, patients described a spectrum of opioid related behavior which both aligned and conflicted with preoperative intentions. Third, there was tension among patients about opioid-free postoperative recovery, with patients expressing support, opposition, and emphasis on tailoring recovery to patient needs. Conclusions: Patients undergoing common surgical procedures often arrive at their surgical encounter with strong, pre-formed opinions about opioids. Eliciting these preexisting opinions may help surgeons better counsel patients about safe opioid use after surgery.

Learning from the implementation of a surgical opioid reduction initiative in an integrated health system: a qualitative study among providers and patients

“…As a result, patients are willing to limit their opioids following surgery and this creates an environment for successfully implementing prescribing reduction initiatives. Similar to our study, another qualitative study among surgical patients revealed widespread awareness among patients about opioid medications which informed their intentions about using opioids [ 49 ]. Ultimately, the patients within our study reported that they were satisfied with their pain management.…”

Patients’ perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study

“…The attitudes related to pain management were also an interesting finding that needs to be addressed. In a qualitative study by Johnson et al (2023) exploring the perceptions and behaviors of patients undergoing elective surgery in relation to opioid pain management, the respondents turned out to have conflicting intentions and opinions regarding postoperative opioid usage, despite being aware of the negative side effects. This was similar to the findings presented in our study in the subcategory confidence in but awareness of opioids .…”

Experiences and perspectives of adults on using opioids for pain management in the postoperative period

“…A total of 437 participants were included in 10 studies. The majority of studies were qualitative (n ¼ 9) 19,[43][44][45][46][47][48][49][50] with one retrospective cohort study with a mixed method approach. 18 Studies were conducted in the UK (n ¼ 2), 19,47 the USA (n ¼ 4), 18,46,48,50 Canada (n ¼ 1), 49 Denmark (n ¼ 1), 43 Sweden (n ¼ 1) 44 and Iran (n ¼ 1).…”

“…45 Most of the studies (n ¼ 9) 19,[43][44][45][46][47][48][49][50] collected data through interviews and one study used an open-ended survey. 18 The time from surgery to interview varied, from within 48 to 72 h after surgery (n ¼ 1), 45 1 week (n ¼ 1), 18 2 to 4 weeks (n ¼ 1), 47 60 days (n ¼ 1), 48 90 days (n ¼ 1) 50 and They had pre-operative intentions to avoid using opioids for their pain management. Because of their opioid perceptions of abuse, overdose or addiction.…”

“…18,44,46,48,50 Knowledge that was important to patients included: understanding the potential benefits and risks of opioid use, 46,50 knowing how to manage postoperative pain with opioids, 44,48 how to safely use opioids and dispose of unused opioids. 18,48 Knowledge of the risks and benefits of opioids varied, with some study participants reporting an overall good understanding of the benefits and negative consequences of opioid use, such as addiction, side effects and overdose 50 whilst another study reported uncertainty in participants' awareness. 46 Poor knowledge of safe opioid disposal was reported in two studies.…”