Purpose
Surgeons often prescribe opioid analgesics for pain management after surgery. However,
we understand little about how patients perceive opioid prescribing and make decisions
to use opioids for postoperative pain management. In this study, we aimed to gain
an understanding of patients’ decision-making process on postoperative opioid use.
Methods
We conducted semi-structured interviews with 30 adult patients undergoing elective
surgery at our institution. The interviews were content-coded for thematic analysis.
We used trust in the medical setting as a conceptual framework to interpret and find
the inherent theory in the data.
Results
We found that participants based their opioid decisions on their trust or distrust
toward various elements of their postoperative pain management. Participants believed
that the surgeons “know,” thereby, reinforcing their trust in surgeons’ postoperative
opioid prescribing to be in the participants’ best interest. Moreover, the positive
reputation of the institution strengthened the participants’ trust. However, participants
conveyed nuanced trust because of their distrust toward the opioid medications themselves,
which were viewed as “suspicious,” and the pharmaceutical companies, that were “despised.”
Despite this distrust, participants had confidence in their inherent ability to protect
themselves from opioid use disorders.
Conclusions
Understanding how patients perceive and form decisions on postoperative opioid use
based on their trust and distrust toward various factors involved in their care highlights
the importance of the patient-doctor relationship and building trust to effectively
address postoperative pain and reduce opioid-related harms.
Clinical relevance
Through a strengthened therapeutic alliance between patients and surgeons, we can
improve our strategies to overcome the ongoing opioid epidemic through patient-centered
approaches.
Key words
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Article Info
Publication History
Published online: December 13, 2021
Accepted:
October 27,
2021
Received:
November 12,
2020
Footnotes
Drs Cho, Billig, and Haase received the American Foundation for Surgery of the Hand Clinical Research Grant (Award 1919). Dr Cho received a surgical scientist training grant in health services and translational research (5-T32-GM008616-16A1) from the National Institutes of Health Ruth L. Kirschstein National Research Service Award. Dr Waljee received funding from the Michigan Department of Health and Human Services and the National Institute on Drug Abuse (R01 DA042859). Dr Chung received funding from the National Institutes of Health , book royalties from Wolters Kluwer and Elsevier, and is a Consultant to Axogen and Integra. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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