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"It was a joint plan we worked out together.” How the I-WOTCH programme enabled people with chronic non-malignant pain to taper their opioids : a process evaluation
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Nichols, Vivien P., Abraham, C. A., Eldabe, S., Sandhu, Harbinder, Underwood, M. and Seers, K. (2023) "It was a joint plan we worked out together.” How the I-WOTCH programme enabled people with chronic non-malignant pain to taper their opioids : a process evaluation. BMJ Open, 13 (12). e074603. doi:10.1136/bmjopen-2023-074603 ISSN 2044-6055.
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Official URL: https://doi.org/10.1136/bmjopen-2023-074603
Abstract
Background:
The I-WOTCH randomised controlled trial found that a group based educational intervention to support people using strong opioids for chronic non-malignant pain helped a significant proportion of people to stop or decrease opioid use with no increase in pain-related disability. We report a linked process evaluation of the group-based intervention evaluated in comparison to a usual-care control group who received a self-help booklet and relaxation CD.
Methods:
We interviewed 18 intervention facilitators, and 20 intervention and 20 control participants who had chronic non-malignant pain and were recruited from general (family) practices in the UK. Quantitative data included change-mechanism questions on the trial questionnaires which explored motivation, expectations, and self-efficacy. Fidelity was assessed by listening to a sample of audio-recorded group sessions and nurse consultations. Quantitative and qualitative data were integrated using ‘follow a thread’ and a mixed methods matrix.
Findings:
Four overarching themes emerged: (i) the right time to taper, (ii) the backdrop of a life with chronic pain, (iii) needing support and (iv) the benefits of being in a group. Delivery fidelity was good, adherence (83%) and competence (79%) across a range of intervention groups. Staff delivering the intervention found three typical responses to the intervention: resistance, open to trying, and feeling it was not the right time. The group experience was important to those in the intervention arm. It provided people with a forum in which to learn about the current thinking about opioid usage and its effects. It also gave them examples of how feasible or personally relevant coming off opioids might be.
Conclusion:
The process evaluation data showed that the I-WOTCH intervention was well delivered, well received and useful for most interviewees. Being “the right time” to taper and having support throughout tapering, emerged as important factors within the context of living with chronic pain.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Warwick Research in Nursing |
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Library of Congress Subject Headings (LCSH): | Chronic pain -- Treatment, Clinical trials, Opioids -- Therapeutic use, Analgesics -- Therapeutic use | ||||||
Journal or Publication Title: | BMJ Open | ||||||
Publisher: | BMJ | ||||||
ISSN: | 2044-6055 | ||||||
Official Date: | 6 December 2023 | ||||||
Dates: |
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Volume: | 13 | ||||||
Number: | 12 | ||||||
Article Number: | e074603 | ||||||
DOI: | 10.1136/bmjopen-2023-074603 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 27 October 2023 | ||||||
Date of first compliant Open Access: | 12 February 2024 | ||||||
RIOXX Funder/Project Grant: |
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