Persistent postoperative opioid use in previously opioid-naïve patients after all-severity surgery - a qualitative study
A group of researchers would like to carry out a project looking at why some people continue to use strong painkillers called opioids for long periods after they have been discharged. However, in order to do this, the researchers will need to access the relevant patient records even though they are not under their care. They would like to discuss with you how acceptable it would be for them to access patient records for this purpose.
If you would like to get involved in this discussion, especially if you have had elective surgery at UCLH please contact Dr Fausto Morell-Ducos fausto.morellducos@nhs.net.
After surgery, patients often have moderate to severe pain which can interfere with their recovery and delay discharge from hospital. Opioids are the main analgesics used to manage this pain, and many patients are discharged with a small supply, after which they stop using them as they recover. However, a small proportion continue to use opioids: this is called persistent postoperative opioid use. Opioids are not an effective treatment for chronic pain, and continued use carries significant risks. We want to understand more about patients’ decisions to stop or to continue using opioids after discharge, and their experiences of stopping or trying to stop using them.
We want to invite patients who were discharged from surgery three months earlier, with opioids for their postoperative pain, to tell us about their experience. For this, we need to contact patients who underwent any surgery (except cancer) three months before, and who were sent home with opioids. It does not seem feasible to recruit patients around the time of surgery or discharge, because it is a busy time, often with many demands on the patient and some anxiety, and we would not expect them to be able to read and consider the invitation carefully and then to recall it three months later. We therefore plan to access hospital notes to identify these patients, then to send them information about the study, followed by a phone call (by the MSci students, who will be trained) a few days later to answer questions and to take consent to an interview if patients agree.
Normally, only the team that provides care to the patient has access to his or her notes. We are not part of that care team, but accessing the notes appears to us to be the only way to identify the pool of patients eligible for the study on the basis of their surgery and their use of opioids at discharge, and to obtain their MyCare details or address, and their phone number, in order to recruit as described above.
Most patients will have stopped using opioids, and will be asked a set of questions by the students about their experience of using opioids, and of stopping them; about any difficulties they had, and any support they had, for instance, from GP or from family members. The interview will be by phone, and take about half an hour. Knowing more about successfully stopping opioids is very helpful information. For the small proportion of patients who continued use for more than a month, and those still using opioids three months after discharge, the students will pass contact details to the clinical psychology trainee. She will also ask a series of questions, but more detailed, about the patient’s experience of using opioids, about trying to stop, and about the support they have had and would have liked to have from GP and from family and friends. This interview will also be by phone or zoom, and take close to an hour.
All information collected will be in patients’ own words, and will be analysed qualitatively. This means putting all the information together, anonymised in terms of the patient who provided it, and drawing out common themes. This will help us to provide better help for patients to stop using opioids postoperatively, whether at discharge or in the weeks following, in order to minimise the number who develop long-term use and associated problems.
UCLH: Dr Fausto Morell-Ducos, consultant, Pain Management Centre; Dr Jamie Smart, Consultant in Anaesthesia and Pain Management; Dr Dereck Gondongwe, Lead Pharmacist.
UCL: Professor Amanda C de C Williams, clinical health psychology; Jennifer Samson, trainee doctoral clinical psychologist; Farah Gala and Blue Rigby, MSci Psychological Sciences students.
