Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering.

Kosakowski S, Benintendi A, Lagisetty P, Larochelle MR, Bohnert ASB, Bazzi AR. Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering. Journal of general internal medicine. 2022 May 1; 37(7):1722-1728.

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Abstract:

BACKGROUND: Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients'' experiences. OBJECTIVE: To explore patients'' perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. DESIGN: Qualitative study. PARTICIPANTS: Patients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of = 50% in the past 2 years in two distinct medical systems and regions. APPROACH: From 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers. KEY RESULTS: Participants (n = 41) had lived with chronic pain for an average of 17.4 years (range, 3-36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes. CONCLUSIONS: From patients'' perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients'' perceptions of the quality and outcomes of opioid tapers. To improve patients'' experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.