Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study

K F Giannitrapani^{1

2}, M J Silveira^{3

4}, A Azarfar^{5

6}, P A Glassman^{7

8}, S J Singer^{5

9}, S M Asch^{5

9}, A M Midboe⁵, M A Zenoni^{10

11}, R C Gamboa⁵, W C Becker^{10

11}, K A Lorenz^{5

9}

Affiliations

¹ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. Karleen@stanford.edu.
² Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA. Karleen@stanford.edu.
³ Geriatric Research Education Clinical Center (GRECC), Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI, USA.
⁴ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁵ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁶ University of Central Florida, Orlando, FL, USA.
⁷ Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA.
⁸ Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁹ Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
¹⁰ Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.
¹¹ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

PMID: 33948790
PMCID: PMC8298631
DOI: 10.1007/s11606-021-06747-z

Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study

K F Giannitrapani et al. J Gen Intern Med. 2021 Jul.

. 2021 Jul;36(7):1867-1874.

doi: 10.1007/s11606-021-06747-z. Epub 2021 May 4.

Authors

Affiliations

¹ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. Karleen@stanford.edu.
² Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA. Karleen@stanford.edu.
³ Geriatric Research Education Clinical Center (GRECC), Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI, USA.
⁴ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁵ Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁶ University of Central Florida, Orlando, FL, USA.
⁷ Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA.
⁸ Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁹ Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
¹⁰ Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.
¹¹ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

PMID: 33948790
PMCID: PMC8298631
DOI: 10.1007/s11606-021-06747-z

Abstract

Background: Cancer pain is highly prevalent and often managed in primary care or by oncology providers in combination with primary care providers.

Objectives: To understand interdisciplinary provider experiences coordinating opioid pain management for patients with chronic cancer-related pain in a large integrated healthcare system.

Design: Qualitative research.

Participants: We conducted 20 semi-structured interviews with interdisciplinary providers in two large academically affiliated VA Medical Centers and their associated community-based outpatient clinics. Participants included primary care providers (PCPs) and oncology-based personnel (OBPs).

Approach: We deductively identified 94 examples of care coordination for cancer pain in the 20 interviews. We secondarily used an inductive open coding approach and identified themes through constant comparison coming to research team consensus.

Results: Theme 1: PCPs and OBPs generally believed one provider should handle all opioid prescribing for a specific patient, but did not always agree on who that prescriber should be in the context of cancer pain. Theme 2: There are special circumstances where having multiple prescribers is appropriate (e.g., a pain crisis). Theme 3: A collaborative process to opioid cancer pain management would include real-time communication and negotiation between PCPs and oncology around who will handle opioid prescribing. Theme 4: Providers identified multiple barriers in coordinating cancer pain management across disciplines.

Conclusions: Our findings highlight how real-time negotiation about roles in opioid pain management is needed between interdisciplinary clinicians. Lack of cross-disciplinary role agreement may result in delays in clinically appropriate cancer pain management.

Keywords: cancer; opioids; pain; qualitative research; veterans.

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Conflict of interest statement

All of the authors report grants from Department of Veterans Affairs during the conduct of the study. Dr. Glassman reports nonfinancial support from U.S. Pharmacopeia as well as nonfinancial support and others from the Food and Drug Administration, outside the submitted work. All other authors declare that they do not have a conflict of interest. This work represents solely the perspectives of the authors and does not reflect the opinions of the authors’ affiliated universities, the Department of Veterans Affairs, or the US Government.

References

1. American Cancer Society. Cancer Facts & Figures 2019. Published 2019. Accessed January 11, 2021. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts...
1. Fallon M, Giusti R, Aielli F, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology. 2018;29:iv166-iv191. doi:10.1093/annonc/mdy152 - PubMed
1. Bonica JJ, Ventafridda V, Twycross R. Cancer pain. In: The Management of Pain. Vol 1. 2nd ed. Lea & Febiger; 1990.
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Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study

Affiliations

Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical