de la Cruz Maxine, Reddy Akhila, Balankari Vishidha, Epner Margeaux, Frisbee-Hume Susan, Wu Jimin, Liu Diane, Yennuraialingam Sriram, Cantu Hilda, Williams Janet, Bruera Eduardo
Departments of Palliative Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Departments of Palliative Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Oncologist. 2017 Jan;22(1):115-121. doi: 10.1634/theoncologist.2016-0266. Epub 2016 Oct 14.
Improper use, storage, and disposal of prescribed opioids can lead to diversion or accidental poisoning. Our previous study showed a large proportion of cancer patients have unsafe opioid practices. Our objective was to determine whether an improvement occurred in the patterns of use, storage, and disposal of opioids among cancer outpatients after the implementation of a patient educational program.
Our palliative care (PC) clinic provides every patient with educational material (EM) on safe opioid use, storage, and disposal every time they receive an opioid prescription. We prospectively assessed 300 adult cancer outpatients receiving opioids in our PC clinic, who had received the EM, and compared them with 300 patients who had not received the EM. The previously used surveys pertaining to opioid use, storage, and disposal were administered, and demographic information was collected. Sharing or losing their opioids was defined as unsafe use.
Patients who received EM were more aware of the proper opioid disposal methods (76% vs. 28%; p ≤ .0001), less likely to share their opioids with someone else (3% vs. 8%; p = .0311), less likely to practice unsafe use of opioids (18% vs. 25%; p = .0344), and more likely to be aware the danger of their opioids when taken by others (p = .0099). Patients who received the EM were less likely to have unused medication at home (38% vs. 47%; p = .0497) and more likely to keep their medications in a safe place (hidden, 75% vs. 70%; locked, 14% vs. 10%; p = .0025).
The use of EM on opioid safety for patients with advanced cancer was associated with improved patient-reported safe opioid use, storage, and disposal. The Oncologist 2017;22:115-121Implications for Practice: Prescription opioid abuse is a fast-growing epidemic that has become more prominent recently, even in the cancer pain population. A previous study reported that 26% of cancer outpatients seen in the supportive care center either lose their pain medications or share their pain medications with someone else. This study demonstrates that the implementation of an opioid educational program and distribution of educational material on opioid safety brings about an improvement in opioid storage, use, and disposal practices in patients being prescribed opioids for cancer-related pain. Our study highlights the importance of consistent and thorough opioid education at every instance in which opioids are prescribed.
处方阿片类药物使用、储存和处置不当可导致药物转移或意外中毒。我们之前的研究表明，很大一部分癌症患者存在不安全的阿片类药物使用行为。我们的目的是确定在实施患者教育项目后，癌症门诊患者阿片类药物的使用、储存和处置模式是否有所改善。
我们的姑息治疗（PC）诊所每次为每位接受阿片类药物处方的患者提供关于阿片类药物安全使用、储存和处置的教育材料（EM）。我们前瞻性地评估了在我们PC诊所接受阿片类药物治疗且已收到EM的300名成年癌症门诊患者，并将他们与300名未收到EM的患者进行比较。使用之前有关阿片类药物使用、储存和处置的调查问卷，并收集人口统计学信息。将分享或丢失阿片类药物定义为不安全使用。
收到EM的患者更了解正确的阿片类药物处置方法（76%对28%；p≤0.0001），与他人分享阿片类药物的可能性更小（3%对8%；p = 0.0311），不安全使用阿片类药物的可能性更小（18%对25%；p = 0.0344），并且更有可能意识到他人服用其阿片类药物的危险性（p = 0.0099）。收到EM的患者家中有未使用药物的可能性更小（38%对47%；p = 0.0497），并且更有可能将药物保存在安全的地方（隐藏，75%对70%；上锁，14%对10%；p = 0.0025）。
对晚期癌症患者使用阿片类药物安全的教育材料与患者报告的阿片类药物安全使用、储存和处置情况改善相关。《肿瘤学家》2017年；22:115 - 121实践意义：处方阿片类药物滥用是一种快速增长的流行病，最近变得更加突出，即使在癌症疼痛患者群体中也是如此。之前的一项研究报告称，在支持性护理中心就诊的癌症门诊患者中有26%要么丢失了他们的止痛药物，要么与他人分享他们的止痛药物。本研究表明，实施阿片类药物教育项目并分发阿片类药物安全的教育材料可改善开具用于癌症相关疼痛的阿片类药物患者的阿片类药物储存、使用和处置行为。我们的研究强调了在每次开具阿片类药物处方时进行持续、全面的阿片类药物教育的重要性。
