Bell Louise V, Fitzgerald Sarah F, Flusk David, Poulin Patricia A, Rash Joshua A
Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada.
Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Can J Pain. 2023 Feb 17;7(1):2156331. doi: 10.1080/24740527.2022.2156331. eCollection 2023.
Balance between benefits and harms of using opioids for the management of chronic noncancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size-fits-all approach that can be executed by prescribers and clinicians when considering this therapy.
The aim of this study was to identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature.
Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias was rated, and confidence in evidence was graded.
Twenty-seven studies reporting data from 599 health care providers were included. Ten themes emerged that influenced clinical decision making when prescribing opioids. Providers were more comfortable to prescribe opioids when (1) patients were actively engaged in pain self-management, (2) clear institutional prescribing policies were present and prescription drug monitoring programs were used, (3) long-standing relationships and strong therapeutic alliance were present, and (4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included (1) uncertainty toward subjectivity of pain and efficacy of opioids, (2) concern for the patient (e.g., adverse effects) and community (i.e., diversion), (3) previous negative experiences (e.g., receiving threats), (4) difficulty enacting guidelines, and (5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation).
Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines.
在使用阿片类药物治疗慢性非癌性疼痛（CNCP）时，必须逐案仔细权衡其利弊。在考虑这种治疗方法时，没有一种适用于所有情况的方法可供开处方者和临床医生采用。
本研究的目的是通过对定性文献的系统评价，确定为CNCP开阿片类药物的障碍和促进因素。
检索了6个数据库，从建库至2019年6月，查找有关北美地区为CNCP开阿片类药物的提供者知识、态度、信念或实践的定性研究。提取数据，评估偏倚风险，并对证据的可信度进行分级。
纳入了27项报告来自599名医疗保健提供者数据的研究。出现了10个影响阿片类药物处方临床决策的主题。当（1）患者积极参与疼痛自我管理，（2）存在明确的机构处方政策并使用了处方药监测计划，（3）存在长期关系和强大的治疗联盟，以及（4）有跨专业支持时，提供者更愿意开阿片类药物。降低开阿片类药物可能性的因素包括：（1）对疼痛主观性和阿片类药物疗效的不确定性，（2）对患者（如不良反应）和社区（即药物转移）的担忧，（3）以前的负面经历（如受到威胁），（4）难以执行指南，以及（5）组织障碍（如预约时间不足和文件记录冗长）。
了解影响阿片类药物处方实践的障碍和促进因素，有助于深入了解可改变的干预目标，从而支持提供者提供符合实践指南的护理。
