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

Authors

David Smith, Kaiser Permanente Center for Health Research, Portland, ORFollow
Lynn DeBar, Kaiser Permanente Center for Health Research, Portland, OR
Jennifer Kuntz, Kaiser Permanente Center for Health Research, Portland, OR
Jill Mesa, Kaiser Permanente Center for Health Research, Portland, OR
Jennifer Schneider, Kaiser Permanente Center for Health Research, Portland, OR

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.

Recommended Citation

Smith D, DeBar L, Kuntz J, Mesa J, Schneider J. Develop patient-focused educational materials and scripting for a randomized trial to reduce opioid use following total hip and total knee arthroplasty. J Patient Cent Res Rev. 2017;4:197.