An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

Abstract

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis (n = 10), spondylosis (n = 6), and low back pain (n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.

Communication between patients and health care professionals about opioid medications

“…In response, patients requested additional information about risks or contributed their own information or understanding to the risk discussion. 12 …”

“… 14 Another study suggested describing the patient's opioid use in the context of current guidelines or institutional policies and non-opioid treatment options for chronic pain as a tool to support decisions regarding opioid tapering. 12 …”

Study protocol for a type III hybrid effectiveness-implementation trial to evaluate scaling interoperable clinical decision support for patient-centered chronic pain management in primary care

“…EPIS describes four phases of implementation for evidence-based interventions and the factors that influence the implementation process and outcomes [ 34 , 35 ]. The “Exploration” phase begins when stakeholders become aware of a public health or clinical need and thus includes our team’s prior work [ 27 , 28 , 36 – 42 ], prior interoperable CDS development for chronic pain [ 31 , 43 ], and the development of this protocol. The “Preparation” phase objectives are to identify barriers and facilitators to implementation, assess need for adaptation, and develop an implementation plan.…”

Opioid Therapy and Implications for Oxidative Balance: A Clinical Study of Total Oxidative Capacity (TOC) and Total Antioxidative Capacity (TAC)

“…Oxidative reactions produce reactive oxygen species (ROS), reactive nitrogen species, reactive carbonyl species, and metal-free radicals. Antioxidant mechanisms are classified as enzymatic (superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx)) or nonenzymatic (vitamin C, vitamin E, glutathione (GSH), thioredoxin system, lipoic acid, carotenoids, and flavonoids), and these control the formation and elimination of free radicals [ 7 , 8 ].…”