Prescribing and use of opioids in chronic non-malignant pain V1
Research type
Research Study
Full title
Barriers and enablers to the prescribing and use of opioids in patients with chronic non-malignant pain
IRAS ID
270017
Contact name
Asma Yahyouche
Contact email
Sponsor organisation
University of Birmingham
Duration of Study in the UK
0 years, 5 months, 29 days
Research summary
Research Summary
Study summary\nLong title: Optimising medication use in chronic non-malignant pain (CNMP) patients, Healthcare professionals and patients’ perspectives of barriers and enablers to the appropriate use of prescribed long-term opioids in CNMP patients’ management using Theoretical Domain Framework\nShort title: Barriers and enablers to the prescribing and use of opioids in patients with chronic non-malignant pain.\nAim\nThe research aims to identify the barriers and enablers to prescribing and use of chronic opioid therapy for chronic non-malignant pain (CNMP) from the perspectives of healthcare professionals and patients.\nStudy Design\nThis research will utilise a qualitative study design based on semi-structured interviews with healthcare professionals and patients with CNMP who are prescribed chronic opioid therapy.\nStudy Participants\n1.\tHealthcare professionals currently treating or managing patients with chronic non-malignant pain receiving chronic opioids therapy. \n2.\tCNMP patients who are receiving chronic opioids therapy.\nThe planned size of the recruitment target: We aim to interview approximately 15 chronic pain healthcare professionals and 20 patients.\nParticipant recruitment \nA.\tHealthcare professionals’ recruitment\nThe research team will distribute the study pack (participant information sheet and consent form) to the healthcare professionals at the recruitment sites. Those who are interested in participating in the study can contact the research team for further information before consenting. In addition, the health care professionals who participate in the study will be encouraged to give the researcher’s contact details to other chronic pain healthcare professionals. We will also recruit healthcare professionals through the acquaintance of the research team and using local practice forums of doctors, pharmacists and nurses.\n\nB.\tPatient recruitment \n1.\tContact via chronic pain clinic staff: CNMP Patients who use opioids long term will be identified by the pain clinic nurse from their medical records during their clinic visit. They will be given a brief description of the study by one of the healthcare professionals. Those who show interest will be given the study pack by a member of the healthcare team that contains the research team contact information (e-mails and contact telephone). Interested patients can contact the research team using the contact details provided in the participant information sheet. Patients who agree to take part in the study will be asked to tell their relatives, friends or colleagues who meet the inclusion criteria about the project, and to provide the researcher’s contact details to any other eligible patients who might be interested in potential participation.\nN.B. The researcher will not directly approach patients first. This will eliminate any risk of coercion. The clinical staff and the researcher will stress that there will be no obligation to participate and that patient’s care will not be affected if they decide not to take part.\nPlanned Study Period\nSix months\n\n\n
Summary of Results
This research delved into the complexities of optimizing opioid use for individuals suffering from chronic non-malignant pain (CNMP), seeking to understand the perspectives of key stakeholders and using these insights to propose an intervention. The investigation comprised a systematic review of previous interventions and three qualitative studies involving community pharmacists, patients with CNMP, clinical pharmacists, and pain consultants.
The systematic review revealed a lack of consistency in intervention approaches, highlighting a predominant focus on patient behavior at the expense of psycho-social factors. The first study uncovered challenges faced by community pharmacists, who saw themselves as patient advocates but encountered obstacles such as limited authority, inadequate training, and time constraints. The second study shed light on the profound impact of pain on patients' lives, emphasizing the importance of supportive healthcare relationships while also revealing feelings of isolation and stigma. The third study underscored the necessity for individualized, patient-centered care, pointing to potential gaps in the training of healthcare providers supporting patients through opioid therapy and tapering.
Synthesizing these findings, the proposed intervention, guided by the Behavior Change Wheel (BCW), aims to enhance provider communication skills, reduce stigma toward CNMP patients, encourage shared decision-making, and facilitate patient education on opioids. This multifaceted intervention is designed as a blended learning program, incorporating provider education, training, persuasion, and modeling. The overarching objective is to foster more appropriate, personalized prescribing and tapering decisions, ultimately leading to patients feeling better understood, supported, and thus improving adherence to treatment regimens.
REC name
Wales REC 3
REC reference
20/WA/0232
Date of REC Opinion
17 Sep 2020
REC opinion
Favourable Opinion