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. 2023 Apr;40(4):343-354.
doi: 10.1007/s40266-023-01011-x. Epub 2023 Mar 27.

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis

Alessandra C Marcelo  1 , Emma K Ho  2   3 , David J Hunter  4 , Sarah N Hilmer  5 , Natali Jokanovic  6 , Joanna Prior  2 , Ana Paula Carvalho-E-Silva  7 , Manuela L Ferreira  2
Affiliations

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis

Alessandra C Marcelo et al. Drugs Aging. 2023 Apr.

Abstract

Introduction: Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest.

Objective: This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs.

Design: This was an observational survey involving a consumer review panel and an HCP review panel.

Participants: 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists (n = 9), pharmacists (n = 7), an orthopaedic surgeon (n = 1), a rheumatologist (n = 1), nurse practitioner (n = 1) and a general practitioner (n = 1), all with at least three years of clinical experience and who reported working closely with this target patient population within the last 12 months.

Methods: Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets.

Results: Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the brochure against several categories, which scored between 53 and 97% positive responses. Similarly, the overall feedback provided by HCPs was 85-100% positive. The modified System Usability Scale scores obtained from HCPs was 55-95% positive, indicating excellent usability. Feedback for the personal plan from both HCPs and consumers was largely positive, with consumers providing the highest positive ratings (80-93%). While feedback for HCPs was also high, we did identify that prescribers were hesitant to provide the plan to patients frequently (no positive responses).

Conclusions: This study led to the development of a leaflet and personal plan to support the reduction of opioid use in older people with LBP or HoKOA. The development of the consumer leaflets incorporated feedback provided by HCPs and consumers to maximise clinical effectiveness and future intervention implementation.

Plain language summary

Opioids are medications that are often used to treat severe or chronic pain. However, they can have serious adverse effects and are not usually recommended for long-term use. This study aimed to create educational materials for patients with chronic low back pain or hip or knee osteoarthritis who are taking opioids and to evaluate the materials’ perceived usability, acceptability, and credibility from the perspective of both healthcare professionals (HCPs) and patients. The materials included a brochure and a personal plan and were developed by a team of researchers and clinicians. Both materials were evaluated by HCPs and patients in separate review panels. The brochure and personal plan were found to be usable, acceptable, and credible by both groups. The materials were created to support patients in reducing their opioid use and were refined based on feedback from both HCPs and patients. The materials may be useful in supporting the complex process of tapering off opioids, which can be hindered by various barriers related to both patients and HCPs.

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Conflict of interest statement

Alessandra C. Marcelo, Emma K. Ho, Sarah N. Hilmer, Natali Jokanovic, Joanna Prior, Ana Paula Carvalho-e-Silva and Manuela L. Ferreira declare that they have no conflicts of interest in relation to this article. David J. Hunter provides consulting advice on scientific advisory boards for Pfizer, Lilly, TLCBio, Novartis, Tissuegene, and Biobone that has no relation to the submitted paper.

Figures

Fig. 1
Fig. 1
Examples of the review process of the consumer information leaflet and personal plan, with quotations of the feedback provided by experts and consumers. HCP healthcare professional, GP general practitioner, SHPA Society of Hospital Pharmacists of Australia, MSK musculoskeletal, QR Quick Response
See this image and copyright information in PMC

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