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Patient Refusal of Patient-Controlled Analgesia: Incidence, Associated Factors, and Reasons-A Prospective
Yue Shen1, Guanyu Yang1, Jing Sang1
1Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Background:
Patient-controlled analgesia (PCA) is an effective method for managing postoperative pain, yet a significant number of eligible patients in China decline its use. The reasons for this refusal are not fully understood, limiting the development of patient-centered pain management strategies. This study aims to investigate the incidence, influencing factors, and underlying reasons for PCA refusal among surgical patients.
Methods:
A prospective, mixed-methods cohort study will be conducted at a tertiary hospital in China. A total of 4,000 adult patients scheduled for surgery and eligible for PCA will be enrolled. Before the standard preoperative anesthesiology consultation, participants will complete a baseline assessment of sociodemographic, clinical, and cognitive factors related to PCA. After a standardized PCA recommendation, patients' acceptance or refusal will be recorded. Quantitative data will first be analyzed using least absolute shrinkage and selection operator (LASSO) regression to select predictors; subsequently, multivariable logistic regression will be used to identify factors associated with refusal. Patients who refuse PCA will be invited to participate in semi-structured interviews to explore their decision-making motivations. Interviews will be documented through detailed written notes and analyzed using qualitative content analysis to identify the primary reasons for refusal; data collection will continue until saturation is reached. Postoperative pain scores and decision regret among refusers will also be assessed.
Discussion:
This study will provide insights into PCA refusal from both quantitative and qualitative perspectives. The findings are expected to inform the development of targeted patient education programs and improve shared decision-making processes, ultimately enhancing postoperative pain management and recovery outcomes.
Trial Registration:
Chinese Clinical Trial Registry (ChiCTR2600116056). Registered on January 5, 2026.
