When Patients Take Charge of Opioids: Self-Management Concerns and Practices Among Cancer Outpatients in the Context of Opioid Crisis

Meghani, Salimah H.; Wool, Jesse; Davis, Jessica R.; Yeager, Katherine A.; Mao, Jun J.; Barg, Frances K.

doi:10.1016/j.jpainsymman.2019.10.029

Cited by 28 publications

(26 citation statements)

References 20 publications

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“…Unrelieved pain and associated emotional burdens emerged as a major theme in this study possibly because patients in this study had moderate to severe pain given the inclusion criterion of the parent study. 47 These pain experiences reflected the kind of complexity that should trigger early and continued co-management of symptoms by the primary oncology and palliative care team. 41 Such approaches have been associated with better pain control over usual cancer care in intervention studies.…”

Section: Discussionmentioning

confidence: 99%

“…The purposive subsample included African American and White patients participating in a larger study of cancer patients’ illness concerns. 47 The parent study included adult outpatients from an urban National Cancer Institute (NCI)-designated cancer center with non-skin solid cancers or multiple myeloma, receiving active or recently completed cancer treatments (e.g., infusion or oral chemotherapy, radiation, cancer surgery, or a combination), and moderate to severe pain (≥4 on a scale of 0-10) in the preceding week (applied during the screening process). These criteria reflected factors that would typically trigger palliative care.…”

Section: Methodsmentioning

confidence: 99%

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“I’m Dealing With That”: Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments

Meghani

Levoy

Magan

et al. 2020

Am J Hosp Palliat Care

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Background: National oncology guidelines recommend early integration of palliative care for patients with cancer. However, drivers for this integration remain understudied. Understanding illness concerns at the time of cancer treatment may help facilitate integration earlier in the cancer illness trajectory. Objective: To describe cancer patients’ concerns while undergoing cancer treatment, and determine if concerns differ among African Americans and Whites. Methods: A 1-time, semi-structured qualitative interview was conducted with a purposive subsample of cancer patients participating in a larger study of illness concerns. Eligible patients were undergoing cancer treatments and had self-reported moderate-to-severe pain in the last week. Analysis encompassed a qualitative descriptive approach with inductive thematic analysis. Results: Participants (16 African American, 16 White) had a median age of 53 and were predominantly females (72%) with stage III/IV cancer (53%). Illness concerns were largely consistent across participants and converged on 3 themes: symptom experience (pain, options to manage pain), cancer care delivery (communication, care coordination and care transitions), and practical concerns (access to community and health system resources, financial toxicity). Conclusions: The findings extend the scope of factors that could be utilized to integrate palliative care earlier in the cancer illness trajectory, moving beyond the symptoms- and prognosis-based triggers that typify current referrals to also consider diverse logistical concerns. Using this larger set of concerns aids anticipatory risk mitigation and planning (e.g. care transitions, financial toxicity), helps patients receive a larger complement of support services, and builds cancer patients’ capacity toward a more patient-centered treatment and care experience.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“I’m Dealing With That”: Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments

Meghani

Levoy

Magan

et al. 2020

Am J Hosp Palliat Care

Self Cite

View full text Add to dashboard Cite

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“…We analyzed a convenience sample of 16 studies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) conducted by the authors at 2 Philadelphia institutions (the University of Pennsylvania and Thomas Jefferson University) in partnership with community-based organizations and students (Table ). Our goal was to summarize the methodologic information in the studies to provide practical guidance for conducting freelisting interviews.…”

Section: Introductionmentioning

confidence: 99%

Practical Guidance for Studies Using Freelisting Interviews

2021

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What is known on this topic?Freelisting is a qualitative interviewing technique used for exploring how groups of people think about a health-related topic in order to engage the community.What is added by this report?We outline 7 practical considerations for conducting freelisting.What are the implications for public health practice?Our recommendations can help inform study design and data collection and analysis for researchers who are interested in using freelisting.

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“…The existing literature has shown many different approaches used-by both patients and healthcare providers-in medical choice situations [16][17][18][19][20]. Additionally, the overall process of decision making in pain management is complex, and input may be derived from multiple factors: the clinician's assessment skills, prescribing knowledge, attitudes, communications skills and their relationship with the patient, including the degree to which shared decision-making occurs [21][22][23]; and the patient's beliefs and attitudes, their capacity to selfmanage medications and their socioeconomic characteristics such as education and racial identity [23][24][25]. Many patient concerns may impact decision making in cancer pain management and pose as attitudinal barriers to optimal opioid use: fear of addiction; fatalism-based on the association of opioids with end of life and fear of death; side-effects; opioid tolerance; concern that focussing on pain will distract from disease treatment or not allow monitoring of disease progression; desire to be a good patient; and concerns regarding compromised immunity [26,27].…”

Section: Introductionmentioning

confidence: 99%

“No thanks, I don’t want to see snakes again”: a qualitative study of pain management versus preservation of cognition in palliative care patients

et al. 2020

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Background Towards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them. Methods We conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis. Results Thirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. Conclusions Decision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

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When Patients Take Charge of Opioids: Self-Management Concerns and Practices Among Cancer Outpatients in the Context of Opioid Crisis

Cited by 28 publications

References 20 publications

“I’m Dealing With That”: Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments

“I’m Dealing With That”: Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments

Practical Guidance for Studies Using Freelisting Interviews

“No thanks, I don’t want to see snakes again”: a qualitative study of pain management versus preservation of cognition in palliative care patients

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