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J Pain. 2017 Nov;18(11):1365-1373. doi: 10.1016/j.jpain.2017.06.008. Epub 2017 Jul 8.

"I'm Not Gonna Pull the Rug out From Under You": Patient-Provider Communication About Opioid Tapering.

Author information

1
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc, Indianapolis, Indiana; Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Electronic address: mmatthia@iupui.edu.
2
Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
3
Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana.
4
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc, Indianapolis, Indiana; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.
5
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
6
Regenstrief Institute, Inc, Indianapolis, Indiana.
7
Department of Consumer Science, Purdue University, West Lafayette, Indiana.

Abstract

In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many health care organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients receiving long-term opioids who perceive benefits and are using their medications as prescribed. Because of the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) explaining-patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential, 2) negotiating-patients needed to have input, even if it was simply the rate of tapering, 3) managing difficult conversations-when patients and providers did not reach a shared understanding, difficulties and misunderstandings arose, and 4) nonabandonment-patients needed to know that their providers would not abandon them throughout the tapering process.

PERSPECTIVE:

Although opioid tapering can be challenging, helping patients to understand individualized reasons for tapering, encouraging patients to have input into the process, and assuring patients they would not be abandoned all appear to facilitate optimal communication about tapering.

KEYWORDS:

Chronic pain; opioid tapering; opioids; patient-centered care; patient-provider communication

PMID:
28690000
PMCID:
PMC6219456
DOI:
10.1016/j.jpain.2017.06.008
[Indexed for MEDLINE]
Free PMC Article

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