From the Department of Surgery, Michigan Medicine; VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Center for Healthcare Outcomes and Policy; and George Washington School of Medicine.
Ann Arbor, Mich.; and Washington, D.C.
Plast Reconstr Surg. 2021 May 1;147(5):1124-1131. doi: 10.1097/PRS.0000000000007841.
Opioids are commonly used following outpatient surgery. However, we understand little about patients' perspectives and how patients decide on postoperative opioid use. This study seeks to investigate aspects of patients' thought processes that most impact their decisions.
The authors conducted semistructured interviews with 30 adults undergoing minor elective hand surgery at one tertiary hospital. Narratives were content-coded to arrive at the authors' thematic analysis. The authors incorporated Bandura's concept of self-agency to interpret the data and develop a conceptual framework that best explained the implicit theory within participants' responses.
The authors found six themes under two domains of self-agency. Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. They would avoid opioids postoperatively because they were "tough" and wanted to evade the risk of addiction as "good citizens." They conveyed a nuanced safety against addiction because they were "not the kind" to become addicted and because they trusted the surgeons' prescribing. However, participants felt discouraged by the stigma associated with opioids. Both intentionally and unintentionally, participants integrated a strong sense of self in their decision-making processes.
A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic. Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes. Surgeons must incorporate patients' individual goals and perspectives regarding postoperative opioid use to minimize opioid-related harm after surgery.
阿片类药物在门诊手术后通常被使用。然而，我们对患者的观点和他们如何决定术后使用阿片类药物知之甚少。本研究旨在调查影响患者决策的主要方面。
作者对在一家三级医院接受小型择期手部手术的 30 名成年人进行了半结构式访谈。对叙述内容进行了内容编码，以得出作者的主题分析。作者将班杜拉的自我效能概念融入其中，以解释数据并开发一个概念框架，该框架最好地解释了参与者反应中的内隐理论。
作者发现了两个自我效能领域下的六个主题。参与者积极寻求支持他们使用阿片类药物决定的保护机制，但有时是无意识地这样做。他们会避免术后使用阿片类药物，因为他们是“坚强的”，并希望避免成瘾的风险，成为“好公民”。他们传达了一种微妙的抗成瘾安全意识，因为他们“不是那种”会成瘾的人，并且信任外科医生的处方。然而，参与者对与阿片类药物相关的污名感到沮丧。参与者有意无意地将强烈的自我意识融入他们的决策过程中。
深入了解患者如何选择服用阿片类药物来控制术后疼痛，对于制定以患者为中心的策略来治疗阿片类药物流行至关重要。有效的阿片类药物减少政策应将患者视为积极的参与者，他们在决策过程中会协商各种内部和外部影响。外科医生必须将患者对术后使用阿片类药物的个人目标和观点纳入其中，以最大程度地减少手术后与阿片类药物相关的伤害。
