Patient Perspectives on Prescription Opioid Discontinuation: Understanding and Promoting Safe Transitions

项目摘要 阿片类药物相关的高死亡率导致临床和政府政策，包括指南 来自疾病控制和预防中心，建议减少阿片类药物的使用。安全 令人担忧的是，这些政策已导致一些医生停止处方长期阿片类药物治疗 （LTOT）突然或没有对患者的支持，这可能会驱使一些患者使用非法阿片类药物或 自杀值得注意的是，尽管药物过量和阿片类药物相关死亡率没有显著下降， 减少阿片类药物的使用。据我们所知，没有研究评估LTOT时的患者体验。 由处方提供者停用。 拟议的研究解决了我们对患者和提供者体验的理解中的这一关键差距， 当面临提供者发起的LTOT中止时的策略和决策。这项研究将解决这一问题 通过对最近停止LTOT的患者进行深入的定性访谈， 停止LTOT处方的提供者，以实现以下目标：1）评估患者和 当提供者开始停止LTOT时，提供者的经验和需求; 2）培养患者 在停止LTOT时支持患者的决策辅助（DA）; 3）对患者进行DA的初步测试。 拟议的研究将在两个州进行，这些州有不同的政策和处方环境， LTOT-华盛顿和阿肯色州。对于目标1，将对100名患者进行定性访谈（50人/人）。 研究中心），其提供商已发起导致LTOT终止的讨论，30家提供商（15家 临床试验机构）为患者停用LTOT。对于目标2，中止LTOT的患者DA将是 开发，符合国际患者DA标准，建立在目标1定性研究结果的基础上 research.目标3将是DA的试点测试，患者在回顾之前和之后完成调查 并与研究干预者进行对话。这些调查将评估执行情况 可行性，可接受性，知识转移，决策冲突，对话质量 DA和患者意图与其初级保健提供者进行随访。 公共卫生影响。随着处方医生现在被鼓励停止处方阿片类药物，对患者的影响 停止LTOT的人包括不安全的戒断经历，感觉被迫寻找风险更大的药物， 阿片类药物（包括致命的芬太尼）的来源，并增加自杀的风险。拟议的研究涉及 知识和资源方面的重大差距，以改善以患者为中心的护理和共同决策， LTOT已停止。DA将提高患者在关键决策方面的参与度，如逐渐减少的速度， 戒断症状管理、替代性疼痛和症状管理以及OUD 评估和治疗方案。从长远来看，DA将通过以下措施改善患者的安全性和结局： 确保他们获得成功终止LTOT所需的支持。

PROJECT SUMMARY High rates of opioid-related mortality have led to clinical and governmental policies, including guidelines from the Centers for Disease Control and Prevention, recommending decreased use of opioids. A safety concern is that these policies have led some physicians to discontinue prescribing long-term opioid therapy (LTOT) abruptly or without support for patients, which could drive some patients to use illicit opioids or to commit suicide. Of note, rates of overdose and opioid-related deaths have not decreased significantly despite reduced use of opioids. No study to our knowledge has evaluated patient experiences when LTOT is discontinued by the prescribing provider. The proposed study addresses this critical gap in our understanding of patient and provider experiences, strategies, and decisions when faced with provider-initiated LTOT discontinuation. The study will address this gap by conducting in-depth, qualitative interviews with patients who have recently discontinued LTOT and providers who discontinued LTOT prescriptions to achieve the following aims: 1) To assess patient and provider experiences and needs when providers initiate discontinuation of LTOT; 2) To develop a patient decision aid (DA) to support patients when discontinuing LTOT; 3) To pilot test the DA with patients. The proposed study will be conducted in two states with diverse policies and prescribing environments for LTOT—Washington and Arkansas. For Aim 1, qualitative interviews will be conducted with 100 patients (50 per site) whose providers have initiated discussions that lead to LTOT discontinuation and 30 providers (15 per site) who discontinued LTOT for their patients. For Aim 2, a patient DA for discontinuing LTOT will be developed, consistent with international patient DA standards, building on findings from the Aim 1 qualitative research. Aim 3 will be a pilot test of the DA in which patients complete surveys before and after they review the DA and have a conversation about it with a study interventionist. The surveys will assess implementation feasibility, acceptability, knowledge transfer, decisional conflict, quality of the conversation generated by the DA and patient intent to follow up with their primary care provider. Public Health Impact. With prescribers now encouraged to stop prescribing opioids, impacts to patients who have LTOT discontinued include unsafe withdrawal experiences, feeling compelled to seek out riskier sources of opioids (including deadly fentanyl), and increased risk of suicide. The proposed study addresses critical gaps in knowledge and resources to improve patient-centered care and shared decision making when LTOT is discontinued. The DA will improve patient engagement around key decisions such as speed of taper, management of withdrawal symptoms, alternative pain and symptom management, as well as OUD assessment and treatment options. In the long-term, the DA will improve safety and outcomes for patients by ensuring they get the support they need to successfully discontinue LTOT.