"I'm Not Gonna Pull the Rug out From Under You": Patient-Provider Communication About Opioid Tapering

Marianne Matthias, Nicole L. Johnson, Cleveland G. Shields, Matthew Bair, Palmer MacKie, Monica Huffman, Stewart C. Alexander

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many health care organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients receiving long-term opioids who perceive benefits and are using their medications as prescribed. Because of the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) explaining-patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential, 2) negotiating-patients needed to have input, even if it was simply the rate of tapering, 3) managing difficult conversations-when patients and providers did not reach a shared understanding, difficulties and misunderstandings arose, and 4) nonabandonment-patients needed to know that their providers would not abandon them throughout the tapering process. Perspective: Although opioid tapering can be challenging, helping patients to understand individualized reasons for tapering, encouraging patients to have input into the process, and assuring patients they would not be abandoned all appear to facilitate optimal communication about tapering.

Original languageEnglish (US)
JournalJournal of Pain
DOIs
StateAccepted/In press - 2017

Fingerprint

Opioid Analgesics
Communication
Negotiating
Pain Management
Ambulatory Care
Practice Guidelines
Chronic Pain
Health Personnel
Health Status
Prescriptions
Organizations
Interviews

Keywords

  • Chronic pain
  • Opioid tapering
  • Opioids
  • Patient-centered care
  • Patient-provider communication

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

"I'm Not Gonna Pull the Rug out From Under You" : Patient-Provider Communication About Opioid Tapering. / Matthias, Marianne; Johnson, Nicole L.; Shields, Cleveland G.; Bair, Matthew; MacKie, Palmer; Huffman, Monica; Alexander, Stewart C.

In: Journal of Pain, 2017.

Research output: Contribution to journalArticle

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