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A qualitative evidence synthesis to explore healthcare professionals’ experience of prescribing opioids to adults with chronic non-malignant pain
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Toye, Fran, Seers, Kate, Tierney, Stephanie and Barker, Karen Louise (2017) A qualitative evidence synthesis to explore healthcare professionals’ experience of prescribing opioids to adults with chronic non-malignant pain. BMC Family Practice, 18 . 94. doi:10.1186/s12875-017-0663-8 ISSN 1471-2296.
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Official URL: https://doi.org/10.1186/s12875-017-0663-8
Abstract
Background
Despite recent guidelines suggesting that patients with chronic non-malignant pain might not benefit, there has been a significant rise in opioid prescription for chronic non-malignant pain. This topic is important because an increasing number of HCPs are prescribing opioids despite very limited evidence for long-term opioid therapy for chronic non-malignant pain outside of end-of-life care. To better understand the challenges of providing effective treatment, we conducted the first qualitative evidence synthesis to explore healthcare professionals’ experience of treating people with chronic non-malignant pain. We report findings that explore healthcare professionals’ experience of prescribing opioids to this group of patients.
Methods
We searched five electronic bibliographic databases (Medline, Embase, CINAHL, PsychINFO, AMED) from inception to November 2015 and screened titles, abstracts and full texts of potential studies. We included studies in English that explored healthcare professionals’ experience of treating adults with chronic non-malignant pain. Two reviewers quality appraised each paper. We used the methods of meta-ethnography developed and refined for large reviews, and the GRADE-CERQual framework to rate confidence in review findings.
Results
We screened 954 abstracts and 184 full texts, and included 77 studies in the full review. 17 of these 77 studies included concepts that explored the experience of prescribing opioids. We abstracted these concepts into 6 overarching themes: (1) Should I, shouldn’t I? (2) Pain is Pain; (3) Walking a fine line; (4) Social guardianship; (5) Moral boundary work; (6) Regulations and guidelines. We used the GRADE-CERQual framework to evaluate confidence in findings. A new overarching concept of ‘ambiguity’ explains the balancing required around the factors taken into account when prescribing opioids. Managing this ambiguity is challenging and these findings can inform healthcare professionals dealing with these decisions.
Conclusions
This conceptual model demonstrates the complexity of making a decision to prescribe opioids to someone with chronic non-malignant pain. Although opioid prescription is underpinned by the therapeutic aim of alleviating pain, this aim may be misplaced. This has implications for education in light of the new regulations for opioid prescription. Findings also demonstrate that the decision is influenced by intra- and interpersonal factors and broader external concerns.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RT Nursing | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Warwick Research in Nursing | ||||||||
| Library of Congress Subject Headings (LCSH): | Opioids -- Prescribing, Chronic pain -- Treatment, Medical personnel | ||||||||
| Journal or Publication Title: | BMC Family Practice | ||||||||
| Publisher: | BioMed Central Ltd. | ||||||||
| ISSN: | 1471-2296 | ||||||||
| Official Date: | 25 November 2017 | ||||||||
| Dates: |
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| Volume: | 18 | ||||||||
| Article Number: | 94 | ||||||||
| DOI: | 10.1186/s12875-017-0663-8 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 29 November 2017 | ||||||||
| Date of first compliant Open Access: | 29 November 2017 | ||||||||
| RIOXX Funder/Project Grant: |
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