Emergency department patients have misperceptions about opioid dependence and want more information about their pain management options, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. The study, published online in the Annals of Emergency Medicine, found that patients seen in the emergency department for acute pain expressed a desire for better communication from physicians about their pain management options, along with discussion of the risks of opioid dependence.
The study used semi-structured open-ended telephone interviews with 23 patients (mostly women, ages 18 to 65) discharged from the Hospital of the University of Pennsylvania after being seen in the emergency department during a four-month period in 2014, for pain related to broken bones in the arms or legs, kidney stones or musculoskeletal back injury. Although the patients discussed a variety of topics related to their experiences with communication around pain, the main themes of the interviews included opioid dependence and addiction, and patient-provider communication about pain management. The themes patients revealed around opioid dependence included:
1) fear of developing dependence or addition,
2) worries about following prescribed dosing preventing the possibility of addiction,
3) relying on media and other individuals as a source of information about opioids, and
4) awareness of physicians’ need to balance patients’ pain management needs and safe opioid prescribing guidelines.
“It was interesting to find that patients believe that taking an opioid as prescribed prevents the possibility of addiction, but also that patients are learning about opioids from television and from friends and acquaintances—not healthcare providers,” said senior author Zachary F. Meisel, MD, MPH, MS, assistant professor and attending physician in the department of Emergency Medicine, who oversaw the study led by Robert J. Smith, BS, a medical student at Penn. “There’s clearly a significant need for emergency departments to improve education around the risks of opioid misuse.”
There were also several themes that emerged around patient-provider communication about pain management. Patients often reported that they desired engagement in decisions about the treatment plan, better communication about the cause of their pain, consideration of how the pain is affecting their life, and more empathy from providers, and they also felt that fragmentation in communication between providers was detrimental to their treatment.
“Patients realize that emergency departments are busy places, but that doesn’t reduce their desire to have meaningful interactions with their care providers,” said Meisel. “Patients want to be given information in a straight-forward way and then listened to, so that they leave feeling like they know what was causing their pain, what their pain management options were, and that their treatment preferences were heard.”
The researchers are now using the data from this study to develop short video narratives of patient stories related to pain in the emergency department, which will then be tested as an intervention to improve patient understanding of their pain management options and the risks associated with opioid misuse.
The other Penn co-authors include Karin Rhodes, MD, MS, Breah Paciotti, MPH, Sheila Kelly, MPH, and Jeanmarie Perrone, MD. Funding was provided by a grant from the Agency for Healthcare Quality and Research (R18HS021956).
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania - recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital - the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.
University of Pennsylvania School of Medicine
Annals of Emergency Medicine