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Opioid Prescribing After Curative-Intent Surgery: A Qualitative Study Using the Theoretical Domains Framework
Jay S Lee1, Vartika Parashar1, Jacquelyn B Miller2
1Division of Surgical Oncology, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
Annals of Surgical Oncology
|April 12, 2018
Summary
Surgeons
Area of Science:
- Implementation Science
- Surgical Oncology
- Healthcare Provider Behavior
Background:
- Excessive opioid prescribing post-surgery is prevalent.
- Factors influencing surgeon prescribing behavior are poorly understood.
- Qualitative study using the Theoretical Domains Framework (TDF) to explore prescribing.
Purpose of the Study:
- Identify factors influencing opioid prescribing behavior among surgeons after curative-intent surgery.
- Utilize the TDF to pinpoint targets for intervention.
- Inform strategies to optimize opioid prescribing practices.
Main Methods:
- Conducted semi-structured interviews with surgical oncology providers.
- Utilized the TDF for coding and analysis of interview transcripts.
- Linked identified domains to behavior change models for intervention selection.
Main Results:
- Five TDF domains influenced prescribing: environmental context, social influences, beliefs about consequences, role/identity, and goals.
- Twenty-one providers (surgeons, PAs, nurses) were interviewed.
- Three interventions identified: nurse-led patient counseling, on-screen prescribing prompts with normative data, and guideline dissemination.
Conclusions:
- Environmental and social factors significantly shape opioid prescribing after surgery.
- Targeted interventions addressing these determinants can improve prescribing in surgical oncology.
- Implementation science frameworks like TDF are valuable for understanding and modifying clinical behaviors.
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