A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery

Area of Science:

• Obstetrics and Gynecology
• Pain Management
• Pharmacology

Background:

• Cesarean delivery is a common surgical procedure associated with significant postoperative pain.
• Opioid analgesics, such as oxycodone, are frequently prescribed for post-cesarean pain, leading to concerns about overuse and diversion.
• Standardized opioid prescribing practices may not align with individual patient needs and pain trajectories.

Purpose of the Study:

• To evaluate the effectiveness of a shared decision-making (SDM) intervention in reducing the quantity of oxycodone prescribed after cesarean delivery.
• To compare patient-chosen oxycodone prescription quantities within an SDM framework to the standard institutional prescription.
• To assess the potential of SDM as a strategy for decreasing postoperative opioid medication waste.

Main Methods:

• A tablet computer-based decision aid was used to facilitate SDM sessions between patients and clinicians.
• Patients received education on pain management and expected opioid use following cesarean delivery.
• Participants chose their oxycodone prescription quantity (5 mg tablets) up to the institutional limit of 40 tablets.

Main Results:

• The study included 51 women who consented to participate.
• The median number of oxycodone tablets chosen by patients was 20.0 (interquartile range 15.0-25.0).
• This patient-chosen quantity was significantly lower than the standard institutional prescription of 40 tablets (P<.001), representing approximately a 50% reduction.

Conclusions:

• A shared decision-making approach significantly reduced the number of oxycodone tablets prescribed post-cesarean delivery.
• This SDM intervention is a promising strategy for decreasing the quantity of leftover opioid medication after cesarean births.
• Implementing SDM in opioid prescribing can lead to more personalized and potentially safer pain management practices.