Hoffensitz Nielsen Sabrina, Kirstine Kousgaard Andersen Merethe, Søndergaard Jens, Bjørnskov Pedersen Line
Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Postal address: Campusvej 55, 5230 Odense M, Denmark.
DaCHE - Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Postal address: Campusvej 55, 5230 Odense M, Denmark.
Prev Med Rep. 2024 Jul 10;45:102821. doi: 10.1016/j.pmedr.2024.102821. eCollection 2024 Sep.
Use of opioids can lead to frequent and severe side effects, prompting the exploration of non-pharmacological alternatives, including nudging, to reduce opioid consumption. This review identifies and evaluates patient-targeted nudges to support opioid tapering among adults with chronic non-cancer pain.
We searched EMBASE, MEDLINE, CINAHL, PsycInfo, and Social Science citation index for articles published from 2010 to January 2023. Eligibility criteria were based on the PICOS framework and included original peer-reviewed English language studies on adults with chronic non-cancer pain and interventions aligning with the nudge definition by Thaler and Sunstein. Studies with relevant comparators, measurable outcomes, real-world data, and pre/post-intervention measures were included. Data were manually extracted and reported in a descriptive manner. The process adhered to PRISMA-ScR reporting guidelines.
Four of 222 articles fulfilled the inclusion criteria. All included nudges aimed at providing information to support decision-making and behavior change. Three nudge categories were identified: increasing salience, understanding mappings, and feedback. Outcome measures were program-related, focusing on perceptions, knowledge acquisition, engagement metrics, and psychological well-being.
There were no statistically significant effects or only small evidence of effects in the program-related outcomes. None of the studies included a control group with standard care or no intervention comparison and none included objective measures of opioid reduction. More studies are needed to draw conclusions on the effectiveness of nudges to support opioid tapering among chronic non-cancer pain patients.
使用阿片类药物会导致频繁且严重的副作用，这促使人们探索非药物替代方法，包括助推，以减少阿片类药物的使用。本综述旨在识别和评估针对患者的助推措施，以支持慢性非癌性疼痛成人患者逐渐减少阿片类药物用量。
我们检索了EMBASE、MEDLINE、CINAHL、PsycInfo和社会科学引文索引，查找2010年至2023年1月发表的文章。纳入标准基于PICOS框架，包括关于慢性非癌性疼痛成人患者的原创同行评审英文研究，以及与泰勒和桑斯坦提出的助推定义相符的干预措施。纳入具有相关对照、可测量结果、真实世界数据以及干预前后测量的研究。数据通过手动提取并以描述性方式报告。该过程遵循PRISMA-ScR报告指南。
222篇文章中有4篇符合纳入标准。所有纳入的助推措施旨在提供信息以支持决策和行为改变。确定了三类助推措施：提高显著性、理解映射和反馈。结果测量与项目相关，侧重于认知、知识获取、参与指标和心理健康。
在与项目相关的结果中，没有统计学上的显著效果，或者仅有少量效果证据。没有一项研究包括接受标准护理或无干预对照的对照组，也没有一项研究包括阿片类药物减少的客观测量。需要更多研究才能得出关于助推措施对支持慢性非癌性疼痛患者减少阿片类药物用量有效性的结论。
