Opioid Tapering and the Patient-Provider Relationship

Matthias, Marianne S.

doi:10.1007/s11606-019-05337-4

Cited by 14 publications

(9 citation statements)

References 10 publications

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“…It is critical for patients to feel that their providers are supportive and accessible throughout tapers, specifically when patients are experiencing difficult physical or mental health symptoms. 15 , 17 , 26 Research could evaluate the impact of regular check-ins with patients as they are undergoing tapers to ensure that the tapering rate and pace are appropriate and any symptoms to the taper are being discussed and addressed.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…Evidence from the literature suggests that a unilateral approach to tapering by physicians often leads to anger and hostility by patients [ 38 ]. Even worse, opioid tapering can lead to termination of care [ 39 ]. Discussions around tapering should be centered around individuals and their clinical circumstances and focused on the positive benefits of abstinence rather than on the negative impact of addiction.…”

Section: Discussionmentioning

confidence: 99%

Discordance in Addressing Opioid Crisis in Rural Communities: Patient and Provider Perspectives

et al. 2022

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Providing patient-centered care to manage chronic pain and opioid use disorder (OUD) is associated with improved health outcomes. However, adopting a holistic approach to providing care is often challenging in rural communities. This study aims to identify and contrast challenges to providing patient-centered care from the perspective of patients and providers. A participatory design approach was adopted to elicit the perceptions of providers and patients with lived experiences of chronic pain and/or OUD in Jefferson County, Wisconsin. Two focus groups were conducted with each stakeholder group to identify problems that participants face with respect to chronic pain management and OUD and possible solutions. Four interviews were conducted with providers experienced in chronic pain management. Analysis of focus group sessions and interviews show consensus among patients and providers that lack of behavioral health and recovery resources create barriers to effectively manage OUD and chronic pain. However, there was discordance among the two groups about other barriers such as patient and provider attitudes, tapering approach, and access to medications for OUD. This tension among patients and providers can influence patients’ retention in therapy. More efforts are needed to mitigate stigma among providers in rural communities and support psychosocial needs of patients.

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“…Consistent with this, prior research into communication between healthcare providers and patients with chronic pain has emphasised the importance of taking an individualised approach to treatment, using nonstigmatising language, validating patients' pain experiences, listening without judgement, showing empathy, engaging in shared decision making, and explicitly committing to nonabandonment. 3,20,33,[35][36][37]53…”

Section: The Importance Of Patient-provider Communicationmentioning

confidence: 99%

A qualitative trajectory analysis of patients' experiences tapering opioids for chronic pain

McNeilage

Avery

Holliday

et al. 2021

Pain

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Tapering opioids for chronic pain can be challenging for both patients and prescribers, both of whom may be unsure of what to expect in terms of pain, distress, activity interference, and withdrawal symptoms over the first few weeks and months of the taper. To better prepare clinicians to provide patient-centred tapering support, the current research used prospective longitudinal qualitative methods to capture individual-level variation in patients' experience over the first few months of a voluntary physician-guided taper. The research aimed to identify patterns in individuals' experience of tapering and explore whether patient characteristics, readiness to taper, opioid tapering self-efficacy, or psychosocial context were related to tapering trajectory. Twenty-one patients with chronic noncancer pain commencing tapering of long-term opioid therapy were recruited from a metropolitan tertiary pain clinic (n 5 13) and a regional primary care practice (n 5 8). Semistructured phone interviews were conducted a mean of 8 times per participant over a mean duration of 12 weeks (N 5 173). Four opioid-tapering trajectories were identified, which we characterised as thriving, resilient, surviving, and distressed. High and low readiness to taper was a defining characteristic of thriving and distressed trajectories, respectively. Life adversity was a prominent theme of resilient and distressed trajectories, with supportive relationships buffering the effects of adversity for those who followed a resilient trajectory. Discussion focuses on the implications of these findings for the preparation and support of patients with chronic pain who are commencing opioid tapering.

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Opioid Tapering and the Patient-Provider Relationship

Cited by 14 publications

References 10 publications

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

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

Discordance in Addressing Opioid Crisis in Rural Communities: Patient and Provider Perspectives

A qualitative trajectory analysis of patients' experiences tapering opioids for chronic pain

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