Developing an intervention to address intersecting prescription opioid and chronic pain stigma in cancer survivors: formative work

制定干预措施以解决癌症幸存者中交叉处方阿片类药物和慢性疼痛耻辱问题：形成性工作

• 批准号: 10173220
• 负责人: JUDITH FEINBERG
• 金额: $ 15.51万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10173220
• 关键词: Address; Advanced Malignant Neoplasm; Aftercare; Attitude; Behavior; Behavior Therapy; Cancer Pain Management; Cancer Patient; Cancer Survivor; Caregivers; Caring; Cessation of life; Chronic Cancer Pain; Clinical; Compulsive Hoarding; Data; Development; Discrimination; Disease; Future; Goals; Health; Health behavior; Healthcare; Individual; Infrastructure; Intervention; Interview; Lead; Literature; Malignant Neoplasms; Nature; Oncologist; Oncology; Opioid; Outcome; Pain; Pain Clinics; Pain management; Pain quality; Palliative Care; Patient-Focused Outcomes; Patients; Persons; Physicians; Population; Practice Management; Primary Health Care; Public Health; Quality of life; Radiation; Reporting; Research; Resources; Risk; Role; Safety; Sampling; Science; Source; Specialist; Stigmatization; Survivors; Time; Tumor Cell Invasion; United States National Institutes of Health; Work; active method; addiction; cancer care; cancer diagnosis; cancer pain; cancer therapy; care providers; chemotherapy; chronic pain; chronic painful condition; coping; curative treatments; design; efficacy testing; emotional distress; experience; high risk; improved; innovation; opioid epidemic; opioid misuse; opioid therapy; opioid use; parent grant; patient-clinician communication; prescription opioid; programs; protective factors; safety outcomes; social; social stigma; standard of care; survivorship

PROJECT SUMMARY/ABSTRACT Advances in cancer diagnosis and treatment have allowed individuals with cancer to survive their disease at high rates. However, survivorship is often accompanied by challenging long-term sequelae such as chronic cancer pain. Though prescription opioids are often prescribed during active treatment, the role of prescription opioids in chronic cancer pain management is less clear. There is little literature as to the safety and efficacy of opioids in this population, so survivors and their clinicians are stuck between two worlds – cancer pain, in which opioids are standard of care, and chronic pain, in which long-term opioids are known to carry significant risk including opioid misuse, addiction, and death. This challenge is particularly impactful in the mist of the opioid epidemic, in which negative public attitudes towards prescription opioids are prevalent. As a result, cancer survivors with chronic pain may be at particularly high risk for stigmatization, a detrimental phenomenon associated with adverse health outcomes (e.g., emotional distress, suboptimal health behaviors and coping strategies, difficult patient-provider communication). We posit that prescription opioid use and chronic pain are two important sources of intersecting stigma in cancer patients. Prescription opioid stigma and chronic pain stigma have been explored separately in other patient groups; however, there is little literature that directly explores these intersecting stigmas in cancer survivors. As the population of cancer survivors on long-term opioid therapy continues to increase, understanding stigma experiences in this group is a time-sensitive, critical need. Consistent with the NIH Helping to End Addiction Long-term (HEAL) initiative’s key priority of enhancing pain management, the aim of this proposal is to obtain a comprehensive understanding of co-occurring prescription opioid and chronic pain stigmas in cancer survivors with chronic pain. The results of this study will support the development of a future multi-level behavioral intervention to mitigate the impact of stigma and improve pain management in this population. Guided by the Health Stigma and Discrimination Framework, we will conduct in-depth qualitative interviews exploring prescription opioid and chronic pain stigma in 20 cancer survivors with moderate-to-severe pain, 20 caregivers, and 20 clinicians who treat patients with chronic cancer pain, including oncologists, primary care providers, pain management specialists, and palliative care physicians. We will conduct thematic analysis to identify potential contributors to stigma in cancer survivors, with an emphasis on potential targets of future interventions, and explore proximal and long-term health outcomes. This proposal is innovative and timely, as we are among the first to advance a comprehensive understanding of intersecting prescription opioid and chronic pain stigma in cancer survivors. We will use this evidence to develop a comprehensive, multi-level behavioral intervention to reduce these stigmas and improve patient outcomes, including pain management and quality of life. This proposal is significant because our research has the potential to promote safe, effective, and informed opioid pain management practices in millions of cancer survivors living with chronic pain

项目总结/摘要 癌症诊断和治疗的进步使癌症患者能够在高风险下生存下来。 rates.然而，生存往往伴随着具有挑战性的长期后遗症，如慢性癌症 痛苦虽然处方阿片类药物经常在积极治疗期间处方，但处方阿片类药物在治疗中的作用是不可忽视的。 慢性癌痛的治疗尚不清楚。关于阿片类药物在治疗中的安全性和有效性的文献很少。 因此，幸存者和他们的临床医生被困在两个世界之间-癌症疼痛，其中阿片类药物是 标准治疗和慢性疼痛，其中已知长期阿片类药物具有显著风险，包括阿片类药物 滥用，上瘾，死亡在阿片类药物流行的迷雾中，这一挑战尤其具有影响力， 公众普遍对处方类阿片持负面态度。因此，患有慢性病的癌症幸存者 疼痛可能特别容易引起污名化，这是一种与不良健康有关的有害现象 结果（例如，情绪困扰，次优健康行为和应对策略，难相处的病人-提供者 通信）。我们认为，处方阿片类药物的使用和慢性疼痛是交叉的两个重要来源， 癌症患者的耻辱感。处方阿片类药物污名和慢性疼痛污名已分别探讨， 然而，很少有文献直接探讨癌症中这些交叉的污名 幸存者随着接受长期阿片类药物治疗的癌症幸存者人数不断增加， 在这一群体中，消除耻辱感是一项具有时间敏感性的迫切需要。美国国立卫生研究院帮助结束 成瘾长期（HEAL）倡议的关键优先事项是加强疼痛管理，本提案的目的是 全面了解癌症中同时发生的处方阿片类药物和慢性疼痛污名 慢性疼痛的幸存者这项研究的结果将支持未来多层次的发展， 行为干预，以减轻耻辱的影响，并改善这一人群的疼痛管理。 在健康污名和歧视框架的指导下，我们将进行深入的定性访谈 在20名患有中度至重度疼痛的癌症幸存者中探索处方阿片类药物和慢性疼痛污名， 护理人员和20名治疗慢性癌症疼痛患者的临床医生，包括肿瘤学家，初级保健 提供者，疼痛管理专家和姑息治疗医生。我们将进行专题分析， 确定癌症幸存者耻辱的潜在因素，重点是未来的潜在目标 干预措施，并探索近端和长期的健康结果。这项建议是创新和及时的，因为我们 是第一批全面了解交叉处方阿片类药物和慢性 癌症幸存者的痛苦耻辱。我们将利用这些证据来制定一个全面的，多层次的行为 干预，以减少这些耻辱和改善患者的结果，包括疼痛管理和质量 生活这一建议意义重大，因为我们的研究有可能促进安全，有效和知情 阿片类药物在数百万患有慢性疼痛的癌症幸存者中的疼痛管理实践