Opioid Tapering
Conditions
Keywords
Chronic pain, Decision Aids, Long-term opioid therapy, Opioid tapering
Brief summary
Because of recent policies to decrease opioid use, some people using long-term opioid therapy (LTOT) are encouraged or required to stop (discontinue) taking opioids. That has led experts to be concerned that patients whose LTOT is discontinued could have untreated pain, turn to other substance use and possibly illicit opioids, or have worsened mental health symptoms leading to suicide. To guide safer policies, guidelines, and care, this study will interview patients and doctors about discontinuing LTOT and use the results to develop a patient-centered decision aid (DA) to improve patient-provider communication around discontinuation of LTOT. Once the DA is finalized, it will be pilot tested with a group of 30 patients who are currently on LTOT. The pilot will assess DA implementation feasibility; acceptability; knowledge transfer; and ability to successfully foster positive, patient-centered conversations about opioid discontinuation.
Interventions
BEHAVIORALPatient-centered Decision Aid to support long-term opioid therapy tapering
Earlier aims of this study developed a patient-centered Decision Aid (DA) that uses stories of people who benefited from discontinuing and clear explanations of evidence for key choices to decrease stigma; empower patients; increase engagement and productive interaction with providers in decision making; and reduce fear, anger and anxiety about tapering. The DA will be designed to support conversations that providers often find challenging and help providers maintain patient trust and satisfaction. Participants in the pilot test will be asked to: 1) complete a pre-DA survey, 2) review the DA, 3) have a guided conversation with a trained study interventionist with a behavioral health background who is trained on how to use the DA, and 4) complete a post-DA survey.
Sponsors
University of Arkansas
University of Washington
Kaiser Permanente
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
EHR-based inclusion criteria: * age 18 or older * LTOT in the past 18 months (LTOT is ≥60 days of ≥50 MEDs day in each of 2 consecutive 90-day periods with medication treatment for OUD excluded) Inclusion criteria confirmed by participant * Have been taking opioids for chronic pain for at least 6 months * Able to speak and read English EHR-based
Exclusion criteria
* cancer diagnosis in the last 5 years (excluding non-melanoma skin cancers) * current palliative or hospice care * cognitive disability * psychiatric hospitalization in the last year * surgery in the last 6 months * current residence in an inpatient rehabilitation or skilled nursing facility
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acceptability of DA | 1-2 weeks | We will use Matlock et al.'s acceptability ranking scale to assess the acceptability of the DA to patients |
Countries
United States
Outcome results
None listed