Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America: a systematic review

Bell, Louise (2020) Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America: a systematic review. Masters thesis, Memorial University of Newfoundland.

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Abstract

The aim of this review was to identify empirically supported barriers and facilitators for prescribing opioids for Chronic Non-Cancer Pain (CNCP) through a systematic review of qualitative literature. Six databases were searched from inception to June 3, 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias rated, and confidence in evidence graded using Cochrane Confidence in the Evidence from Reviews of Qualitative research (CERQual). Constructs identified were coded using the Theoretical Domains Framework. Twenty-six studies reporting on 599 healthcare providers were included. Fourteen constructs were identified as barriers or facilitators to prescribing opioids for CNCP that fell within seven domains. Domains and constructs identified as barriers included: (1) Environmental Context, (a) patient-related salient events (e.g., overdose), (b) provider-related salient events (e.g., threat by patient), and (c) time constraints; (2) Emotion, (a) concerns over problematic use, addiction, dependence, tolerance, and side effects, and (b) regulatory scrutiny; (3) Knowledge; (4) Beliefs About Consequences; and (5) Beliefs About Capabilities. Domains and constructs identified as facilitators included: (1) Environmental Context, (a) lack of available non-opioid alternatives, and (b) institutional pressure; (2) Social Influences, (a) patient-provider relationship, and (b) patient-provider communication; (3) Goals; and (4) Knowledge on opioid prescribing tools. Understanding the barriers and facilitators that influence opioid-prescribing offers important insight into modifiable targets for interventions that can support providers in delivering care consistent with guidelines to manage CNCP, while minimizing risks.

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