Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering

Abstract

Background Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences. Objective To explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. Design Qualitative study. Participants Patients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions. Approach From 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers. Key Results Participants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3–36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes. Conclusions From patients’ perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients’ perceptions of the quality and outcomes of opioid tapers. To improve patients’ experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.

“I really had somebody in my corner.” Patient experiences with a pharmacist-led opioid tapering program

“…Similar to other studies, 8,12,31 many of the limitations reported by STORM program patients related to a need for additional resources to treat pain or tapering adverse effects. Nearly half of patients expressed frustration with nonpharmacological pain management suggestions provided by pharmacists; patients found these suggestions redundant to options they had already tried or unaffordable.…”

“…Our findings reiterate past findings of the importance of provider empathy with patient experiences, mentally preparing patients for tapering, and individualizing tapering plans. 8,12,31 The incorporation of these elements facilitated the success of the STORM program, and based on findings from our study, additional program elements in line with these themes could be key to improving STORM and designing new programs.…”

“…Recent research has revealed that rapid, inflexible, or unsupported opioid tapering in patients with years of continuous prescription opioid use can exacerbate withdrawal symptoms and have negative impacts on mood and functioning. 8,12,[31][32][33] Although we did not inquire specifically about long-term impacts of tapering, 44% of patients indicated improved quality of life after tapering, whereas 28% reported that their quality of life was adversely affected during or after the taper. Those reporting adverse impacts expressed frustration that their pain was not relieved after tapering, found that ongoing or increased pain affected their ability to remain active, and/or experienced intense withdrawal symptoms that they did not feel sufficiently prepared or supported through.…”

“…Our study was conducted among a population similar to that included in previous opioid tapering research and identified similar barriers and facilitators to opioid tapering. 8,12,[29][30][31][32][33] Generally, our patients appear to be representative of many patients who taper their opioids. The majority reported long Abbreviations used: STORM, Support Team Onsite Resource for Management of Pain; PCP, primary care provider.…”

Evidence based opioid weaning with behavioral support – Forum for Behavioral Science Edition

“…9,10,11 Frequent visits (at least monthly but often weekly if there are comorbid mental health conditions) with the physician and behavioral health team are recommended during a taper. 12 At these visits progress and patient experience are reviewed, risks and benefits are evaluated, and adjustments are made to the plan. It is often appropriate to "pause" a taper while a patient adjusts to their new dose.…”