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2018 Quality Care: New Approach Successfully Reduces Opioid Use After Urologic Oncology Surgery

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Key Points

  • The first pillar of the researchers’ strategy entailed developing care pathways for postoperative pain control utilizing nonopioid medications and therapies as first-line.
  • The second pillar involved changing postoperative conversations with patients.
  • Researchers found that after the new processes were put in place, there was no increase in pain and anxiety among patients in the 24- and 48-hour window post-operation, compared to the previous approach.

In a study conducted by Stanford Health Care, researchers achieved a 46% reduction in opioid use among 443 patients with cancer who underwent a range of urologic surgeries without increasing their pain or anxiety. They achieved this reduction through a two-pillared approach: (1) maximizing the use of over-the counter nonopioid therapies and (2) changing the nature of postsurgery discussions with patients. These findings will be reported by Stevenson et al at the upcoming 2018 ASCO Quality Care Symposium, to be held September 28–29 in Phoenix (Abstract 269).

“While opioids can be an effective pain management tool for cancer patients, there is a risk of addiction, particularly for people who have recently undergone surgery,” said lead author Kerri Stevenson, a nurse practitioner at Stanford Health Care. “We found that when you have conversations with patients about pain control, including nonopioid therapies available and the potential risks associated with opioids, they appreciate being involved in their own care, and, subsequently, have a reduced need for opioid medications.”

Strategy Pillars

The first pillar of the researchers’ strategy entailed developing care pathways for postoperative pain control utilizing nonopioid medications and therapies as first-line. This included educating providers and nurses about the availability and efficacy of the treatment plans. Patients were still prescribed opioids—but at lower doses, and only escalated if necessary.

The second pillar involved changing postoperative conversations with patients. Rather than having nurses routinely asking patients whether they wanted any pain medication, referring to opioids, they discussed the current nonopioid medications patients were receiving for pain, along with their frequency and dosage, and asked whether those medications were sufficient. In addition, the care team was trained to discuss the potential side effects of opioids of which patients may not be aware.

The authors developed these processes after reviewing daily opioid use, pain scores, and anxiety scores for patients recovering from surgery for urologic cancers over a 4-month period (from November 2017 to March 2018) and analyzing the factors contributing to excessive opioid use. They also designed pain regimens using varying combinations of nonopioid medications.

Results of Strategy

Researchers found that after the new processes were put in place, there was no increase in pain and anxiety among patients in the 24- and 48-hour window post-operation, compared to the previous approach.

“With the new approach, opioids were never withheld, but they were no longer the automatic default for patients and providers,” Ms. Stevenson said. “Our study shows that it’s possible to decrease patients’ reliance on opioids after surgery, and that health-care providers have an important role to play in the nationwide effort to combat the opioid epidemic.”

The authors believe their approach could be applicable to other types of surgeries in various diseases, but that it would need to be tested under different circumstances and with a greater number of patients.

To see a full list of author disclosures, refer to the study abstract.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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