Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers.

Fereydooni, S; Lorenz, K; Azarfar, A; Luckett, T; Phillips, JL; Becker, W; Giannitrapani, K

Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers.

Fereydooni, S Lorenz, K Azarfar, A Luckett, T

Phillips, JL Becker, W Giannitrapani, K

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ Open, 2024, 14, (3), pp. e082033
Issue Date:: 2024-03-21

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Field	Value	Language
dc.contributor.author	Fereydooni, S
dc.contributor.author	Lorenz, K
dc.contributor.author	Azarfar, A
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Phillips, JL
dc.contributor.author	Becker, W
dc.contributor.author	Giannitrapani, K
dc.date.accessioned	2024-08-06T03:19:53Z
dc.date.available	2024-02-28
dc.date.available	2024-08-06T03:19:53Z
dc.date.issued	2024-03-21
dc.identifier.citation	BMJ Open, 2024, 14, (3), pp. e082033
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/180106
dc.description.abstract	INTRODUCTION: Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. METHODS: We conducted a secondary analysis of the raw semistructured interview data gathered from 42 prescribers who participated in one of two aligned concurrent qualitative studies in the USA and Australia. We conducted a two-part analysis of the interview: first identifying all factors influencing long-term prescribing and second open coding-related content for themes. RESULTS: Factors that influence long-term opioid prescribing for cancer-related pain clustered under three key domains (patient-related, provider-related and practice-related factors) each with several themes. Domain 1: Patient factors related to provider-patient continuity, patient personality, the patient's social context and patient characteristics including racial/ethnic identity, housing and socioeconomic status. Domain 2: Provider-related factors centred around provider 'personal experience and expertise', training and time availability. Domain 3: Practice-related factors included healthcare interventions to promote safer opioid practices and accessibility of quality alternative pain therapies. CONCLUSION: Despite the differences in the contexts of the two countries, providers consider similar patient, provider and practice-related factors when long-term prescribing opioids for patients with cancer. Some of these factors may be categorised as cognitive biases that may intersect in an already disadvantaged patient and exacerbate disparities in the treatment of their pain. A more systematic understanding of these factors and how they impact the quality of care can inform appropriate interventions.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation.ispartof	BMJ Open
dc.relation.isbasedon	10.1136/bmjopen-2023-082033
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.classification	52 Psychology
dc.subject.mesh	Humans
dc.subject.mesh	United States
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Practice Patterns, Physicians'
dc.subject.mesh	Australia
dc.subject.mesh	Pain
dc.subject.mesh	Neoplasms
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Pain
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	United States
dc.subject.mesh	Australia
dc.subject.mesh	Practice Patterns, Physicians'
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Humans
dc.subject.mesh	United States
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Practice Patterns, Physicians'
dc.subject.mesh	Australia
dc.subject.mesh	Pain
dc.subject.mesh	Neoplasms
dc.title	Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers.
dc.type	Journal Article
utslib.citation.volume	14
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	University of Technology Sydney/All Manual Groups
pubs.organisational-group	University of Technology Sydney/All Manual Groups/Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2024-08-06T03:19:51Z
pubs.issue	3
pubs.publication-status	Published online
pubs.volume	14
utslib.citation.issue	3

Abstract:

INTRODUCTION: Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. METHODS: We conducted a secondary analysis of the raw semistructured interview data gathered from 42 prescribers who participated in one of two aligned concurrent qualitative studies in the USA and Australia. We conducted a two-part analysis of the interview: first identifying all factors influencing long-term prescribing and second open coding-related content for themes. RESULTS: Factors that influence long-term opioid prescribing for cancer-related pain clustered under three key domains (patient-related, provider-related and practice-related factors) each with several themes. Domain 1: Patient factors related to provider-patient continuity, patient personality, the patient's social context and patient characteristics including racial/ethnic identity, housing and socioeconomic status. Domain 2: Provider-related factors centred around provider 'personal experience and expertise', training and time availability. Domain 3: Practice-related factors included healthcare interventions to promote safer opioid practices and accessibility of quality alternative pain therapies. CONCLUSION: Despite the differences in the contexts of the two countries, providers consider similar patient, provider and practice-related factors when long-term prescribing opioids for patients with cancer. Some of these factors may be categorised as cognitive biases that may intersect in an already disadvantaged patient and exacerbate disparities in the treatment of their pain. A more systematic understanding of these factors and how they impact the quality of care can inform appropriate interventions.

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http://hdl.handle.net/10453/180106