Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study.

Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study.

Publication date: May 10, 2019

Longstanding variation in the views of family physicians (FPs) on the role of opioids seems to translate into widely varying prescribing rates. Improvement interventions are unlikely to achieve change if they do not understand and explicitly target the factors that determine physician prescribing behaviour. The aim of this work was to understand (1) the perspectives of FPs as it relates to opioid prescribing, and (2) the perceived barriers and enablers to guideline-adherent opioid prescribing and management of chronic non-cancer pain.

A qualitative study involving one-on-one, semi-structured interviews with a sample of FPs in Ontario, Canada. Interviews were analyzed using a directed content analysis informed by the Theoretical Domains Framework. A framework approach was used to explore interaction across behavioural determinants (factors influencing behaviour) as well as demographic sources of variation. The behaviour of interest for the current study was the prescribing of opioid medications (including initiation, renewal, and dose reduction) for patients with chronic, non-cancer pain. Associated issues in the overall management of such patients were also explored.

Interviews were conducted with 22 FPs. Behavioural determinants interacted with one another to influence FPs prescribing behavior. The TDF domain Beliefs about Consequences played a central role in explaining physician prescribing behaviours as they related to the management of chronic non-cancer pain. Individual beliefs about prescribing consequences and patient behaviour interacted with prescriber beliefs about capabilities and perceptions of the FP’s professional role to influence prescriber behaviour. Emotion and the environmental context influenced the impact of these determinants on opioid prescribing and the management of chronic non-cancer pain.

FPs face a wide range of complex (and often interacting) challenges when prescribing opioid therapy to their patients. Solution-based strategies should target these determinants directly using evidence-based strategies that move beyond guideline dissemination and general education. Shared decision-making strategies and patient-facing decision aids are likely to decrease the tension experienced in challenging conversations.

Desveaux, L., Saragosa, M., Kithulegoda, N., and Ivers, N.M. Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study. 03501. 2019 BMC Fam Pract (20):1.

Concepts Keywords
BMC Palliative care
Canada Nociception
Cancer Pain Medical terminology
Demographic Pain
Emotion Opioid
Ontario Morphine
Opioid Pain management
Opioids Chronic non cancer
Physician Behaviours related management

Semantics

Type Source Name
disease DOID aids
disease MESH aids
gene UNIPROT FANCE
gene UNIPROT ELOVL6
disease DOID face
gene UNIPROT IMPACT
gene UNIPROT SRY
disease DOID cancer
disease MESH cancer
gene UNIPROT DNMT1
gene UNIPROT CD69
gene UNIPROT CD5L
gene UNIPROT FDPS
gene UNIPROT FES

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