Patient and Provider Acceptability of a Patient Preauthorized Concealed Opioid Reduction

Bedford, Theresa; Adediran, Timileyin; Haycock, Nathaniel R.; Mullins, C. Daniel; Medeiros, Michelle; Wright, Thelma; Curatolo, Michele; Hamlin, Lynette; Colloca, Luana

doi:10.1093/pm/pnaa454

Cited by 3 publications

(12 citation statements)

References 25 publications

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“…In this article, we performed content analyses of previously published survey responses to further examine perspectives toward pre-authorized concealed opioid taper scenarios. We have previously reported the quantitative findings of this study ( 13 ). The purpose of this qualitative analysis is to provide an in-depth understanding of attitudes toward a concealed taper strategy in both patients and clinicians.…”

Section: Introductionsupporting

confidence: 52%

“…In addition, there is limited empirical evidence to support best practices for successful opioid tapering in patients with chronic pain ( 11 , 12 ). We conducted a survey of both patients and clinicians to explore attitudes toward a pre-authorized concealed taper of opioids with the purpose of gathering critical knowledge to implement in future trials using a concealed taper ( 13 ). The research used a mixed-methods approach: closed-ended questions with forced-choice answers, followed by the opportunity for respondents to reply with open-ended comments.…”

Section: Introductionmentioning

confidence: 99%

“…The research used a mixed-methods approach: closed-ended questions with forced-choice answers, followed by the opportunity for respondents to reply with open-ended comments. When presented with scenarios ( 13 ) related to a hypothetical trial with pre-authorized concealed taper of opioids, both clinicians and patients believed that a concealed taper is more likely to be successful than a standard taper. Nearly 50% of the patients who responded to the survey were willing to participate in the hypothetical trial of pre-authorized concealed taper of opioids, and almost 80% of clinicians were willing to refer patients to such a clinical trial.…”

Section: Introductionmentioning

confidence: 99%

“…Nearly 50% of the patients who responded to the survey were willing to participate in the hypothetical trial of pre-authorized concealed taper of opioids, and almost 80% of clinicians were willing to refer patients to such a clinical trial. Patients and clinicians alike saw the proposed concealed opioid reduction as a possible way to mitigate clinical pain, opioid-related side effects, and withdrawal symptoms ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

et al. 2022

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Standard opioid tapers tend to be associated with increased patient anxiety and higher pain ratings. Pre-authorized concealed opioid reductions may minimize expectations such as fear of increased pain due to the reduction of opioids and, prolong analgesic benefits in experimental settings. We recently observed that patients and clinicians are open to concealed opioid tapering. However, little is known about the “why” behind their attitudes. Based on this lack of data, we analyzed qualitative responses to survey questions on patients' and clinicians' acceptance of a concealed opioid reduction for chronic pain. Seventy-four patients with a history of high dose opioid therapy and 49 clinicians completed a web-based questionnaire with open-ended questions examining responses to two hypothetical clinical trials comparing a concealed opioid reduction pre-authorized by patients vs. standard tapering. We used content analysis based on qualitative descriptive methodology to analyze comments from the patients and clinicians. Five themes were identified: informed consent; anxiety; safety; support; and ignorance is bliss, or not. These themes highlight the overall positive attitudes toward concealed opioid tapers. Our findings reinforce the importance of patient-centered care and are expected to inform the design of clinical trials from both the patient and clinician perspective. This qualitative study presents patients' and clinicians' attitudes toward hypothetical scenarios for a trial of pre-authorized reduction of opioids. The findings indicate positive attitudes and the relevance of engaging patients with effective decision-making processes.

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Section: Introductionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

et al. 2022

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“…You will have the opportunity to contact your provider any time and receive explanations and, if needed, rescue therapies. ” (page 8, 3 ).…”

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confidence: 99%

Veteran engagement in opioid tapering research: a mission to optimize pain management

Colloca

Kisaalita

Bizien

et al. 2021

PR9

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More than 50 million Americans suffer from chronic pain, and approximately 20 million individuals have severe chronic pain that interferes with life or work activities. 15 This is a particular concern for the Veterans Health Administration (VHA) as chronic pain has been found to be more common, severe, and complex in Veterans. 32,40 In addition to chronic pain, military Veterans often suffer from other complex medical and mental health issues. 33 Opioid analgesics are often used to treat chronic noncancer pain (CNCP); however, there is insufficient evidence that longterm use improves chronic pain or functioning. 9,24 Furthermore, long-term opioid use is associated with increased mood disorders prevalence 1 and several potential harms including overdose (OD), the development of opioid use disorder (OUD), and possibly death. Nearly 10 million Americans misuse or abuse opioids, which may elevate the risk for developing OUD. An estimated 2 million individuals have OUD, and to date, approximately 450,000 people have died by OD from prescription or illicit opioids. Approximately 81,230 drug OD deaths occurred in the United States in the 12 month ending in May 2020. 36 One study showed that Veterans were twice as likely to die from accidental OD compared with non-Veterans, indicating a strong correlation to dose and to mental health comorbidities. 6 The 2017 Veterans Health Administration /Department of Defense (DoD) Clinical Practice Guideline for Opioid Therapy recommends against initiating long-term opioid therapy for chronic pain. 19,39 Similarly, the Centers for Disease Control and Prevention recommends additional caution for prescribing .50 mg morphine equivalent daily dose (MEDD) and recommends against .90 mg MEDD. 16 In general, the recommendation is to keep opioid therapy at the lowest dosage and shortest duration possible, in conjunction with the implementation of opioid risk mitigation strategies 26 and consideration of issues related to telehealth, care coordination, stepped care model implementation, 19 and suicide prevention. 34 Unfortunately, there are no generally accepted clinical guidelines for opioid tapering that are evidence based. Furthermore, there is no clear scientific evidence regarding the optimal speed of tapering or consistent/scheduled taper vs individualized tapers with frequent adjustments. Moreover, fears surrounding opioid tapering often lead to high dropout rates in these studies making this a challenging area to research. 25 The dearth of published comparative effectiveness studies of tapering in patients on long-term opioids for CNCP represents a major clinical dilemma. 4 The CDC guidelines suggest 10% to 20% reduction per week as "reasonable" but also noted that for many patients a much slower taper would be appropriate. 16,20 In 2019, the Department of Health and Human Services issued an opioid tapering guide, warning against opioids tapered rapidly or discontinued suddenly, and stated that slower tapers (eg, #10% per month) are often better tolerated than more rapid tapers. 2,38 T...

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Healthcare consumers' and professionals' perceived acceptability of evidence‐based interventions for rural transitional care

Fox

Sidani

Zaheer

et al. 2022

Worldviews Ev Based Nurs

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Background: There is a pressing need for high quality hospital-to-home transitional care in rural communities. Four evidence-based interventions (discharge planning, treatments, warning signs, and physical activity) have the potential to improve rural transitional care. However, there is limited understanding of how the perceptions of healthcare consumers and professionals compare on the acceptability of the interventions. Convergent views on intervention acceptability support implementation, whereas divergent views highlight areas requiring reconciliation prior to implementation. Aims: This study compared the acceptability of four evidence-based interventions proposed for rural transitional care, as perceived by healthcare consumers and professionals. Methods: A cross-sectional, comparative design was used. The convenience sample included 36 healthcare consumers (20 patients and 16 family caregivers) who had experienced a hospital-to-home transition in the past month and 30 healthcare professionals (29 registered nurses and one nurse practitioner) who provided transitional care in rural Ontario, Canada. Participants were presented with descriptions of the four interventions and completed an established intervention acceptability measure. Presentation of the four intervention descriptions and respective acceptability measures was randomized to control for possible order effects. The perceived overall acceptability of the interventions and their attributes (i.e., effectiveness, appropriateness, risk, and convenience) were compared using independent samples t-tests.Results: Consumer ratings were consistently higher across all four interventions in terms of overall acceptability as well as effectiveness, appropriateness, and convenience (all p's < .01; effect sizes 0.70-1.13). No significant between-group differences in perceived risk were found.Linking evidence to action: Contextual and methodological differences may account for variability in ratings, but further research is needed to explore these propositions.The results support future qualitative inquiry targeting professionals to better understand their perspectives on the effectiveness, appropriateness, and convenience of the four interventions.

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Patient and Provider Acceptability of a Patient Preauthorized Concealed Opioid Reduction

Cited by 3 publications

References 25 publications

Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

Veteran engagement in opioid tapering research: a mission to optimize pain management

Healthcare consumers' and professionals' perceived acceptability of evidence‐based interventions for rural transitional care

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