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

项目摘要/摘要 癌症诊断和治疗的进展使患有癌症的人能够在高处生存 费率。但是，生存通常伴随着挑战长期后遗症，例如慢性癌 疼痛。尽管处方阿片类药物通常在主动治疗期间处方，但处方阿片类药物在 慢性癌症疼痛管理还不太清楚。关于阿片类药物的安全性和效率的文献很少 这个人口，因此生存及其临床医生被困在两个世界之间 - 癌症疼痛，阿片类药物是 众所周知，长期卵巢类药物在内的护理标准和慢性痛 滥用，成瘾和死亡。这一挑战在Ooid流行病的雾中尤其有影响 负面公众参加处方阿片类药物很普遍。结果，癌症生存为慢性 疼痛可能是污名化的风险特别高，这是与不良健康相关的有害现象 结果（例如，情绪困扰，次优健康行为和应对策略，困难的患者培训 沟通）。我们指出，处方使用和慢性疼痛是相交的两个重要来源 癌症患者的污名。处方Ooid污名和慢性疼痛污名已在 其他患者群体；但是，很少有文献直接探讨癌症中的这些相交的污名 幸存者。随着长期阿片类药物疗法的癌症存活人数继续增加，理解 该小组中的污名经历是时间敏感，批判性的需求。与NIH的帮助结束一致 成瘾长期（治愈）倡议提高疼痛管理的关键重点，该提议的目的是 获得对癌症中同时发生处方阿片类药物和慢性疼痛污名的全面了解 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 行为干预以减轻污名的影响并改善该人群的疼痛管理。 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 探索20种癌症生存中的处方Oioid和慢性疼痛污名，中度至重度疼痛，20 护理人员和20位治疗慢性癌症患者的临床医生，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。我们将进行主题分析 确定对癌症存活中污名的潜在贡献者，重点是未来的潜在目标 干预措施，探索代理和长期健康成果。正如我们一样，该提议具有创新和及时 是最早对相交处方Ooid和慢性的全面理解的人之一 癌症存活中的疼痛污名。我们将使用这些证据来发展全面的多层次行为 干预以减少这些污名并改善患者的结果，包括疼痛管理和质量 生活。该提案很重要，因为我们的研究有可能促进安全，有效和知情 数以百万计的癌症生存的静脉疼痛管理实践患有慢性疼痛