The Inclusion of Patients’ Reported Outcomes to Inform Treatment Effectiveness Measures in Opioid Use Disorder. A Systematic Review

Abstract

Introduction Patient centred care is needed now more than ever in the treatment of opioid use disorder. Trials, policy makers, and service providers have most often used treatment retention and opioid urine screens as measures of treatment effectiveness. However, patients receiving medication for opioid use disorder treatment (MOUD) may prioritise the use of different ways to assess treatment success. Objective The aim of this review is to synthesize literature examining the self-reported goals patients would like to achieve in MOUD for opioid use disorder. Methods We searched MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, the National Institutes for Health Clinical Trials Registry, and the WHO International Clinical Trials Registry Platform from inception until April 30th, 2021. No restrictions were placed on language, age, or type of MOUD. A qualitative synthesis is presented given that a meta-analysis was not possible. Results The search yielded a total of 21,082 records from which 8 met criteria for inclusion in the qualitative synthesis. We identified a total of 43 patient-reported treatment goals from the 8 studies. Twelve domains were created from the 43 goals reported. These domains cover a range of important areas for patients’ goals related to living a normal life, physical health, mental health, treatment, and substance use specific areas. Conclusion This review highlights several patient goals that they would like to achieve during treatment for opioid use disorder that are not commonly considered as markers of treatment effectiveness. Goals related to health, living a normal life, and overall substance use concerns by patients should be taken into consideration by clinical trialists, researchers, policy makers, service providers, patients, and communities engaged in developing and tailoring treatment plans for opioid use disorder. Systematic Review Registration PROSPERO CRD42018095553.

Sorting through life: evaluating patient-important measures of success in a medication for opioid use disorder (MOUD) treatment program

“…Some traditional measures of MOUD success, such as being tested for HIV, decreasing overdose, and decreasing hospital visits are often used as measures for “quality of life” for people who use drugs [ 10 , 35 , 37 , 47 ]. Our results were not aligned with these measures, nor were they in other recent literature with patient-derived measures of MOUD success [ 21 , 42 ]. Facets of quality of life such as emotional regulation and housing stability took precedence over health-related variables.…”

“…For PWUD, other traditional outcomes of not being physically dependent on a drug and not being arrested were frequently named as highly important but did not rise to a level of high rank, indicating these might not be relevant current concerns for participants and reflect a point of divergence from providers’ primary priorities for them. These findings are part of a growing literature supporting an expanded understanding of how services providers could evaluate the progress of their participants that is more congruent with the treatment goals of their participants [ 21 , 42 ].…”

“…Presenting these reduced categories to MOUD participants to identify their priority areas represents a truly patient-centered approach to working to achieve a range of life goals. As recommended elsewhere, these can be developed into scales and surveys for use with future patients to inform treatment structure [ 21 , 42 ].…”

“…Authors of a recent systematic review reported 12 domains of importance to people with OUD. While these included traditional metrics, such as treatment retention and abstinence from other drugs, they also placed importance on improvements in daily life, physical health, and discontinuing MOUD [ 42 ]. Authors called for deeper qualitative investigation into outcomes important to patients.…”

“…These studies, however, did not ask MOUD participants to rank items within themes, or the themes themselves, in terms of importance. Most studies have been conducted in settings outside of the United States, with different MOUD regulations and program structures [ 9 , 18 , 30 , 39 , 42 , 43 ]. Two studies in the United States focused exclusively on participants in methadone programs [ 17 , 36 ].…”