Patients' Perspectives on Tapering of Chronic Opioid Therapy: A Qualitative Study
Patients' Perspectives on Tapering of Chronic Opioid Therapy: A Qualitative Study
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DOI：
10.1093/pm/pnw078
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发表时间：
2016-10-01
期刊：
影响因子：
3.1
通讯作者：
Binswanger, Ingrid A.
中科院分区：
文献类型：
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作者：
Frank, Joseph W.;Levy, Cari;Binswanger, Ingrid A.
客观的。没有足够的证据表明长期阿片类药物治疗（COT）的长期益处，并且越来越多的证据表明慢性阿片类药物治疗（COT）的风险。减少阿片类药物剂量或逐渐减少阿片类药物剂量可能会降低这些风险，但也可能会恶化疼痛和生活质量。我们的目标是探讨患者对阿片类药物逐渐减少的看法。设计。使用面对面的半结构化访谈进行定性研究。环境和患者。科罗拉多州三个卫生保健系统中讲英语的成年初级保健患者 (N = 24)。方法。采访内容均在 ATLAS.ti 中进行录音、转录和分析。我们使用了以健康信念模型为指导的基于团队的归纳和演绎混合方法。我们根据多学科团队的意见反复完善了新兴主题。结果。参与者的平均年龄为 52 岁，其中 46% 为男性，79% 为白人。 6 名参与者 (25%) 正在接受 COT，但未逐渐减量，12 名参与者 (50%) 目前正在逐渐减少 COT，6 名参与者 (25%) 已停止 COT。新兴主题分为四个领域：风险、障碍、促进因素和收益。患者认为过量服用阿片类药物的风险较低，并优先考虑阿片类药物逐渐减少带来的更直接的疼痛增加风险。障碍包括认为非阿片类药物缺乏有效性以及对阿片类药物戒断的恐惧。在有阿片类药物逐渐减少经验的患者中，社会支持和值得信赖的医疗保健提供者促进了阿片类药物逐渐减少。这些患者赞同逐渐减少剂量后生活质量得到改善。结论。支持阿片类药物逐渐减少的努力应该引起患者的感知障碍，并寻求与家人、同伴和提供者建立关系以促进逐渐减少。未来的工作应确定以患者为中心的可行策略来支持逐渐减少 COT。
Objective. There is inadequate evidence of longterm benefit and growing evidence of the risks of chronic opioid therapy (COT). Opioid dose reduction, or opioid tapering, may reduce these risks but may also worsen pain and quality of life. Our objective was to explore patients' perspectives on opioid tapering.Design. Qualitative study using in-person, semi-structured interviews.Setting and Patients. English-speaking, adult primary care patients (N = 24) in three Colorado health care systems.Methods. Interviews were audio recorded, transcribed, and analyzed in ATLAS.ti. We used a team-based, mixed inductive and deductive approach guided by the Health Belief Model. We iteratively refined emergent themes with input from a multidisciplinary team.Results. Participants had a mean age of 52 years old, were 46% male and 79% white. Six participants (25%) were on COT and not tapering, 12 (50%) were currently tapering COT, and 6 (25%) had discontinued COT. Emergent themes were organized in four domains: risks, barriers, facilitators, and benefits. Patients perceived a low risk of overdose and prioritized the more immediate risk of increased pain with opioid tapering. Barriers included a perceived lack of effectiveness of nonopioid options and fear of opioid withdrawal. Among patients with opioid tapering experience, social support and a trusted health care provider facilitated opioid tapering. These patients endorsed improved quality of life following tapering.Conclusions. Efforts to support opioid tapering should elicit patients' perceived barriers and seek to build on relationships with family, peers, and providers to facilitate tapering. Future work should identify patient-centered, feasible strategies to support tapering of COT.