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Dangerous Variation or Patient-Centered Care? Palliative Care and Pain Providers' Comfort, Experiences, and Approaches when Treating Cancer Pain With Coexisting Aberrant Behaviors.
Hadler, Rachel A; Klinedinst, Rachel; Jones, Christopher A; Bao, Yuhua; Pathak, Ravi; Zarrabi, Ali J; Rosa, William E.
Afiliação
  • Hadler RA; Department of Anesthesiology, Emory University, Atlanta, GA, USA.
  • Klinedinst R; Emory Critical Care Center, Emory University, Atlanta, GA, USA.
  • Jones CA; Palliative Care Alliance, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
  • Bao Y; Palliative Care Program, Department of Medicine, Duke University, Durham, NC, USA.
  • Pathak R; Department of Population Health Sciences, Weill-Cornell Medicine, New York, NY, USA.
  • Zarrabi AJ; Department of Anesthesiology, Emory University, Atlanta, GA, USA.
  • Rosa WE; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA.
Am J Hosp Palliat Care ; : 10499091241259034, 2024 Jun 03.
Article em En | MEDLINE | ID: mdl-38830349
ABSTRACT

BACKGROUND:

Patients with cancer-related pain are at high risk for aberrant drug use behaviors (ADB), including self-escalation, diversion and concurrent illicit substance or opioid misuse; however, limited evidence is available to guide opioid prescribing for patients with life-limiting illness and concurrent or suspected ADB. We sought to characterize how specialists evaluate for and manage these high-risk behaviors in patients with cancer-related pain.

METHODS:

We conducted telephonic semi-structured interviews with palliative care and pain medicine providers. Participants discussed their own comfort and experience level with identifying and managing ADB in patients with life-limiting illness. They were subsequently presented with a series of standardized scenarios and asked to describe their concerns and management strategies.

RESULTS:

95 interdisciplinary pain and palliative care specialists were contacted; 37 agreed to participate (38.9%). Analysis of interview contents revealed several central themes (1) widespread discomfort and anxiety regarding safe and compassionate opioid prescribing for high-risk patients, (2) belief that widely used risk-mitigation tools such as opioid contracts and urine drug screens provided inadequate support for decision-making, and (3) lack of institutional and organizational support and guidance for safe prescribing strategies. Most clinicians reported self-education regarding addiction and alternative prescribing/pain management strategies. Providers varied widely in their willingness to discontinue opioid prescribing in a patient with aberrant behavior and pain associated with life-limiting illness.

CONCLUSION:

Providers caring for patients demonstrating ADB and cancer-related pain struggle to balance safe prescribing with symptom management. Increased guidance is needed regarding opioid prescribing, monitoring, and discontinuation in high-risk patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Am J Hosp Palliat Care Assunto da revista: ENFERMAGEM Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Am J Hosp Palliat Care Assunto da revista: ENFERMAGEM Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos