Background & Aims

Chronic non cancer pain (CNCP) is a common reason for seeking health care, including primary care(1,2). Thus, general practitioners (GPs) play a central role in the health care system, generally being the first and last resort for patients with chronic pain(1,3,4). The literature describes a complex situation for general practitioners (GPs) concerning CNCP and opioid therapy, including patient, patient-doctor, and healthcare-societal factors to consider (5). In favor of multi-professional and person centered interventions from a biopsychosocial perspective, opioid therapy for CNCP is not recommended(6–8). However, current guidelines are vague, assessments must be made individually, and clinicians lack specific guidance in making complicated decisions such as which patients are suitable for the treatment and which are eligible for opioid tapering(9–11). ). Here, we aimed to understand GPs sense-making of opioid prescribing and opioid tapering for chronic non-cancer pain and their utilization of multiprofessional collaboration.

Methods

A qualitative design with semi-structured interviews for data collection was used. Twelve GP’s working in primary care in Uppsala County, Sweden, were purposefully recruited (12). Variation was sought regarding gender, age, work experience, type of employment, and socio-demographic catchment area. For data analysis, a phenomenological hermeneutic analysis, according to Lindseth et al. was applied (13,14) including naïve understanding, structural/thematic analysis, and comprehensive understanding. Procedures to enhance trustworthiness and credibility included keeping a research diary to enable a structured and systematic record of the analyses and interpretative process, and engaging in reflexivity throughout the research process. Each transcript was reviewed, looking for similarities and differences within and across study participants’ interviews, and a multi-analyst, interdisciplinary investigator triangulation enabled different perspectives on the data.

Results

Two main themes, with three and two subthemes respectively, emerged from the analysis: “To endure the ethical conflict of opioid prescribing” (subthemes ”The responsibilites of opiod prescribing”, ”assessing the effect” and ”legitimizing opioid prescribing”) and “The battle field of opioid prescribing” (subthemes “the battle starts with a no” and “GPs´ unique position”). Prescribing opioids was experienced as ethically challenging due to the risks associated with opioids and a source of intra- and interpersonal as well as organizational conflicts. A way to avoid interpersonal conflicts was to deprioritize opioid tapering and prioritize the therapeutic alliance between the GP and the patient. The GP’s considered themselves the last resort in the healthcare system, and the GP’s often felt an obligation not to abandon the patient, i.e., to continue prescribing even when the effects were unclear. The GPs considered themselves responsible for the opioid therapy, but they were happy to collaborate more with other professions concerning pain treatment.

Conclusions

Our findings are interesting given the primary care setting in Sweden where most health care centers, in addition to GPs also have access to physiotherapists and psychologists, and there is theoretically room for interprofessional collaboration. However, dealing with opioid prescription for long-term pain was perceived as a dilemma and may be associated with uncertainty in the GP role. The study identified barriers for multiprofessional collaboration in Swedish primary care, e.g., lack of time and that the GP’s often felt that they were responsible for the patient’s medical treatment and that this could not be delegated to other professionals. Furthermore, communication with patients about opioid treatment and opioid tapering was considered difficult due to lack of time and knowledge.

References

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Presenting Author

Anna Svensson

Poster Authors

Anna Svensson

MD, MSc

Department of Public Health and Caring Sciences, Uppsala University, Sweden

Lead Author

Sofia Kälvemark-Sporrong

PhD

Department of Pharmacy, Uppsala University, ³Utrecht Institute for Pharmaceutical Sciences

Lead Author

Thomas Kempen

PhD

Department of Pharmacy, Uppsala University, ³Utrecht Institute for Pharmaceutical Sciences

Lead Author

Magnus Peterson

PhD

Department of Public Health and Caring Sciences, Uppsala University, Sweden

Lead Author

Hanna Ljungvall

PhD

Department of Pharmacy, Uppsala University, ³Utrecht Institute for Pharmaceutical Sciences

Lead Author

Topics

  • Treatment/Management: Pharmacology: Opioid