Patient and Provider Perspectives on Managing Pain With Opioids After Cesarean Delivery or Hysterectomy [18F]. (May 2020) - Shi, Carol
Abstract : INTRODUCTION: Despite the prevalence of opioid prescribing after Cesarean delivery (CD) and hysterectomy in the United States, little is known about patients' concerns regarding pain management and physicians' attitudes regarding opioid prescribing practices. We conducted focus groups to characterize patient and provider perspectives on prescription opioid utilization, storage, and disposal. METHODS: We recruited women who had a recent CD or hysterectomy and physicians who perform CD and/or hysterectomy. Focus group discussions covered barriers to individualized opioid prescriptions, content of pain management conversations, and preferences for educational materials for safe opioid utilization, storage, and disposal. Approval was obtained from Women & Infants' Institutional Review Board. RESULTS: We conducted a total of 6 focus group sessions: 2 CD (n=21), 2 hysterectomy (n=18), and 2 with physicians who perform CDs and/or hysterectomies (n=12). Patient experiences with postoperative pain management were highly varied. While some avoided opioids despite maximum doses prescribed, others described concerns such as fear of pain that motivated them to consume more opioids. Patients reported that physicians often did not consult them about medication preferences or pain control expectations. Physicians were unsure how other members of the medical team counseled patients about opioid utilization and were unaware of best practices for safe opioid disposal. Patients' concerns regarding pain management with opioids often coincided with absent, inconsistent, or unclear counseling from providers. CONCLUSION: Optimizing physician-patient discussions of pain expectations, individualized opioid prescribing, and education about safe opioid storage and disposal throughout the perioperative period may improve patient experiences and adherence to best practices for opioid utilization.