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.
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患者对改善阿片类药物锥度期间患者提供者关系和提供者沟通的看法。
DOI：
10.1007/s11606-021-07210-9
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发表时间：
2022-05
影响因子：
5.7
通讯作者：
Bazzi, Angela R.
中科院分区：
文献类型：
--
作者：
Kosakowski, Sarah;Benintendi, Allyn;Lagisetty, Pooja;Larochelle, Marc R.;Bohnert, Amy S. B.;Bazzi, Angela R.
减少阿片类药物过量死亡的努力已经导致逐渐减少（即，减少或停止）阿片类药物处方，尽管对患者的经历了解有限。探讨患者对阿片类药物逐渐减量经历的看法，以最终改善逐渐减量过程和结局。定性研究。在两个不同的医疗系统和地区接受长期阿片类药物治疗慢性疼痛的患者，在过去2年内阿片类药物每日处方剂量减少≥50%。从2019年到2020年，我们进行了半结构化的访谈，这些访谈进行了录音，转录，系统编码和分析，以总结内容并确定有关锥形体验的关键主题，并特别关注患者-提供者关系和锥形期间的提供者沟通。参与者（n=41）患有慢性疼痛的平均时间为17.4年（范围：3-36年），并描述了阿片类药物逐渐减量的一般不良经历，其启动并不总是充分合理或向他们解释。逐渐减量的后果从轻微到严重不等，包括戒断、行动问题、情绪困扰、心理健康症状加重和社会耻辱感，这些症状通常得不到足够的支持。叙述强调了患者-供应商关系在整个逐渐减量经验中的重要作用，大多数参与者描述了重大的人际挑战，包括供应商沟通不畅和患者参与决策有限。一些参与者确定了提供者，关系和沟通的质量，促进了更积极的锥度经验和结果。从患者的角度来看，阿片类药物逐渐减少会产生显著的身体，情感和社会后果，有时会减少对医疗保健的信任和参与。患者-提供者关系和沟通影响患者对阿片类药物逐渐减量的质量和结果的看法。为了改善患者对阿片类药物逐渐减少的体验，逐渐减少计划应基于个性化的风险-效益评估，并涉及以患者为中心的方法和改善的提供者沟通。在线版本包含补充材料，可通过10.1007/s11606-021-07210-9获得。
Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences. To explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. Qualitative study. 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. 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. 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. 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. The online version contains supplementary material available at 10.1007/s11606-021-07210-9.
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影响因子：
3.1
作者：
Frank, Joseph W.;Levy, Cari;Binswanger, Ingrid A.
通讯作者：
Binswanger, Ingrid A.
DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
影响因子：
3.5
作者：
Roper KL;Jones J;Rowland C;Thomas-Eapen N;Cardarelli R
通讯作者：
Cardarelli R
影响因子：
33.7
作者：
Dowell, Deborah;Haegerich, Tamara M.;Chou, Roger
通讯作者：
Chou, Roger