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Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a
Soraya Fereydooni1, Karl Lorenz2, Azin Azarfar3
1Yale University, New Haven, Connecticut, USA soraya_fe@ymail.com.
BMJ Open
|March 21, 2024
Summary
When prescribing long-term opioid therapy for cancer pain, clinicians consider patient, provider, and practice factors. Understanding these elements can improve pain management and reduce disparities in care.
Area of Science:
- Oncology
- Pain Management
- Medical Ethics
Background:
- Long-term opioid therapy for cancer pain involves complex risk-benefit assessments.
- Understanding factors influencing prescribing decisions is crucial for optimizing patient care.
Purpose of the Study:
- To identify patient, provider, and contextual factors affecting long-term opioid prescribing for cancer patients.
- To explore how these factors influence clinical decision-making in different healthcare settings.
Main Methods:
- Secondary analysis of qualitative data from 42 prescribers in the USA and Australia.
- Two-part interview analysis: identifying influencing factors and open coding for themes.
Main Results:
- Opioid prescribing decisions are influenced by patient factors (continuity, personality, social context, demographics), provider factors (experience, training, time), and practice factors (safer prescribing interventions, alternative therapies).
- These factors were consistent across both countries, suggesting universal influences on long-term opioid prescribing for cancer pain.
Conclusions:
- Clinicians utilize similar patient, provider, and practice-related factors when prescribing long-term opioids for cancer pain.
- Cognitive biases may exacerbate existing patient disadvantages and contribute to pain treatment disparities.
- Systematic understanding of these factors is essential for developing targeted interventions to improve pain care quality.
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