VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, CA.
Stanford University School of Medicine, Stanford, CA.
JCO Oncol Pract. 2021 Jul;17(7):e1038-e1047. doi: 10.1200/OP.20.00679. Epub 2021 Feb 3.
To understand how patients and providers weigh the risks and benefits of long-term opioid therapy (LTOT) for cancer pain.
Researchers used VA approved audio-recording devices to record interviews. ATLAS t.i., a qualitative analysis software, was used for analysis of transcribed interview data. Participants included 20 Veteran patients and 20 interdisciplinary providers from primary care- and oncology-based practice settings. We conducted semistructured interviews and analyzed transcripts used thematic qualitative methods. Interviews explored factors that affect decision making about appropriateness of LTOT for cancer related pain. We saturated themes for providers and patients separately.
Factors affecting patient decision-making included influence from various information sources, persuasion from trusted providers, and sometimes deferral of the decision to their provider. Relative prioritization of pain management as the focal patient concern varied with some patients describing comparatively more fear of chemotherapy than opioid analgesics, comparatively more knowledge of opioids in relation to other drugs;patients expressed a preference to spend the limited time they have with their oncologist discussing cancer treatment rather than opioid use. Factors affecting provider decision making included prognosis, patient goals, patient characteristics, and provider experience and biases. Providers differed in how they weigh the relative importance of alleviating pain or avoiding opioids in the face of treating patients with cancer and histories of substance abuse.
Divergent perspectives on factors need to be considered when weighing risks and benefits. Policies and interventions should be designed to reduce variation in practice to promote equal access to adequate pain management. Improved shared decision-making initiatives will take advantage of patient decision-making factors and priorities.
了解患者和提供者如何权衡长期阿片类药物治疗（LTOT）治疗癌症疼痛的风险和益处。
研究人员使用 VA 批准的音频录制设备来记录访谈。ATLAS t.i.，一种定性分析软件，用于分析转录的访谈数据。参与者包括来自初级保健和肿瘤学实践环境的 20 名退伍军人患者和 20 名跨学科提供者。我们进行了半结构化访谈，并使用主题定性方法分析了转录本。访谈探讨了影响有关癌症相关疼痛的 LTOT 是否适当的决策的因素。我们分别对提供者和患者进行了主题饱和。
影响患者决策的因素包括来自各种信息源的影响、来自信任的提供者的劝说，以及有时将决策推迟给他们的提供者。将疼痛管理作为患者关注的焦点进行相对优先排序的情况因患者而异，一些患者对化疗的恐惧比对阿片类镇痛药的恐惧相对较大，对阿片类药物与其他药物的了解相对较多；患者表示宁愿花有限的时间与肿瘤学家讨论癌症治疗而不是阿片类药物的使用。影响提供者决策的因素包括预后、患者目标、患者特征以及提供者的经验和偏见。提供者在面对患有癌症和药物滥用史的患者时，在减轻疼痛或避免使用阿片类药物方面，权衡相对重要性的方式有所不同。
在权衡风险和益处时，需要考虑因素的不同观点。应设计政策和干预措施，以减少实践中的差异，促进平等获得充分的疼痛管理。改进的共同决策举措将利用患者的决策因素和优先事项。
