Purpose: Treatment of chronic non-cancer pain (CNCP) with opioids is a major medical and social challenge for primary care providers. We performed a focus group to help understand the attitudes, emotions, and thoughts of providers as they reflect on treating patients with opioids for CNCP.
Methods: As part of a multi-faceted quality improvement study being conducted at a family medicine residency program, 10 faculty and residents participated in a focus group to discuss their experiences and perceptions in managing patients with CNCP. Participants responded to a series of opinion and statistical statements about the opioid epidemic, as well as clinical vignettes. A trained medical student, in the presence of key investigators, moderated the focus group. Responses were audio-recorded and aliases were used. Attention was given to participants' emotions through the use of a recording tool. Non-verbal expressions, including tone and body language, were interpreted and then equated to one or more emotions. The audio recording of de-identified responses was transcribed and analyzed by investigators.
Results: Focus group participants listed the following difficulties when treating CNCP: time constraints, poor communication between medical specialties/providers/ patients, lack of training on patient risk stratification, and non-opioid treatment options. Absence of a standardized approach to CNCP management was listed as the most significant barrier. Providers admitted to being influenced by past experiences and patient stigmatization when managing CNCP. Providers described the great majority of experiences managing CNCP as negative, especially if patients had been on opioids for many years and had unrealistic expectations regarding pain level and functional goals. Among 16 emotions, the most commonly exhibited by participants during the focus group were: engaged, agreeing, calm, and quiet.
Conclusions: Focus group participants expressed challenges managing patients with CNCP. A predominance of negative experiences were reported. However, positive emotions exhibited during the focus group reinforced the hypothesis that providers appreciate the opportunity to share their experiences on this sensitive topic. Input obtained during the focus group was used to help our institution develop standardized practice guidelines for the use of opioids for CNCP in the primary care setting and other related educational activities that are currently in progress.
Flores K, McDearmon S, Phelps B, Kram JJ, Baumgardner DJ, Kotovicz F. FP059: Understanding providers' emotions and thoughts regarding opioid use for the management of chronic non-cancer pain in a family medicine residency program. Presented at 49th STFM Annual Spring Conference, 2016.