Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering

Background Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences. Objective To explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. Design Qualitative study. Participants Patients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions. Approach From 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers. Key Results Participants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3–36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes. Conclusions From patients’ perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients’ perceptions of the quality and outcomes of opioid tapers. To improve patients’ experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.

Opioid Dosage Levels, Concurrent Risk Factors and Self-Perceptions among Chronic Pain, Opioid-Managed Individuals at Elevated Risk for Opioid Overdose

While current opioid prescribing guidelines highlight a dose-response relationship between therapeutic management and overdose risk, other concurrent risk factors have also been identified. However, there is little data in assessing the relationship between risk factor prevalence, associated provider communication, and subsequent perceptions of overdose risk among chronic pain, opioid-managed (CPOM) patients. An online questionnaire was distributed in June 2020 to a sample of CPOM individuals (n = 190) treated with an opioid prescription at or above 50 daily MME, or any dosage alongside benzodiazepines. CPOM individuals reported a mean daily MME of 470, with half (52.6%) receiving a concurrent benzodiazepine prescription. All patients reported past month alcohol use, and 67.4% indicated a risk-elevating diagnosed medical condition. In assessing provider communication, 41.6% reported no discussion focusing on the risks of one’s opioid therapy. Subsequently, 62.1% perceived themselves as having “no risk”, and 60.0% were “not at all concerned” (60.0%) about experiencing an opioid overdose. Organizational policies should focus on implementing consistent methods of patient education regarding overdose risk, as well as assessments of behaviors or characteristics that my increase an individual’s risk of opioid overdose. These policies should also include other forms of evidence-based overdose risk prevention such as co-prescriptions of naloxone.

Provider Communication and Loneliness in Senior Living Communities During the COVID-19 Pandemic

Prior research has demonstrated the impact of the COVID-19 pandemic on feelings of loneliness, but relatively little is known about loneliness in the context of senior living communities (SLCs). Indeed, the pandemic has led SLCs to enact new safety precautions, including visitor restrictions, intended to reduce the spread of COVID-19, which may have serious consequences for the psychosocial well-being of residents. Drawing on a sample of 733 adults ages 54 to 100 living in one of nine SLCs in December 2020 (response rate = 60%), linear regression models were used to examine whether perceived communication between SLCs and residents during the COVID-19 pandemic influenced feelings of loneliness. Analyses also considered whether this association varied as a function of education. Our findings reveal that 53% of respondents were very lonely during the pandemic. However, older adults who perceived that their SLC had been helpful to their understanding of the pandemic were significantly less lonely (p < 0.01), adjusting for sociodemographic and health characteristics. Moreover, we found that less educated older adults derived the greatest benefit from effective communication about the pandemic (p < 0.05). Those with less education reported feeling lonelier if they did not perceive that their SLC communicated in a way that helped them better understand the pandemic; there was no such association for those with higher education. The findings from this study provide support for the resource substitution hypothesis and demonstrate the importance of communication in alleviating feelings of loneliness during the COVID-19 pandemic.

Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care

Background Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU? Methods This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process. Results We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge. Conclusions Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.

Disparity on Online Patient-Provider Communication and Implications for a Post-COVID Era

Online patient-provider communication (OPPC) increases access to health-related information, enhances self-care, and reduces healthcare expenditures. We investigated OPPC and technology use changes during 6 years. This descriptive cohort analysis involved data collected from the National Health and Aging Trends Study (NHATS) between 2011-2016 and during the pandemic (2020). NHATS consist of a nationally representative sample of Medicare beneficiaries. From a total of N=2,389, we assigned cohorts as those who: (1) own computers (High-Tech, 56.1%), (2) own cell phone only or don’t own computer nor cell phones (Low-Tech, 20.2%), and (3) just adopted cell phone or computers (Transition, 23.7%). Only the High-Tech users increased OPPC by 75% over 2011-2016; others remained the same. During the pandemic more participants used mobile technology and internet. Newly adopting technology on its own does not automatically increase OPPC. It is important for Transition users to access training and support to benefit from OPPC.