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Article Title

Develop Patient-Focused Educational Materials and Scripting for a Randomized Trial to Reduce Opioid Use Following Total Hip and Total Knee Arthroplasty

Publication Date

8-10-2017

Keywords

qualitative research, pharmaceuticals, costs

Abstract

Background: The American Academy of Orthopaedic Surgeons recognizes the unintended consequences of focusing on opioids for pain management.

Methods: This was a qualitative study with open-ended, structured interviews (n = 18) at Kaiser Permanente Northwest. A purposeful sampling method identified surgeons, advice nurses, physical therapists, physician assistants and patients. Patients were recent total hip/knee arthroplasty (THA/TKA) cases in the top third of opioid use after surgery. Interview guides captured feedback consistently. Provider interviews explored their approach with THA/TKA patients on: pain management, barriers to opioid titration, and recommendations/changes on educational materials to support pain management and opioid reduction. Patient interviews explored their experience, understanding and beliefs surrounding opioids, and recommendations on important content. A qualitative methodologist conducted interviews and content analysis to identify key themes.

Results: Recommendations for content in patient educational materials and scripting included: 1) Clear descriptions of how opioids work in the body, how to taper, nonopioid pain management options, and problems from overuse (eg, side effects and pain masking); 2) Messaging on how long to expect to use opioids and type of pain to expect; 3) Providing a visual timeline for patients to reinforce pain medication titration expectations and home or physical therapy exercises, especially during the acute phase; 4) Emphasis on the multimodal approach to pain management and the importance of a balance between opioids for recovery versus overuse; 5) Explanations to chronic opioid users that their pain and its management may vary from opioid-naïve patients; and 6) Provide education and messaging multiple times prior to and after surgery.

Conclusion: Patients and providers agreed that clearly stated verbal and written messaging is needed beyond what has typically been done regarding opioid expectations; the resulting materials are being tested in an ongoing trial.

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