A study is currently underway on the proper treatment of patients with serious illnesses, those who abuse opioids or who have an opioid use disorder Open. Ultimately, the results of the study will be used to develop a toolkit for clinicians caring for patients with serious medical conditions who are at risk for opioid abuse or opioid use disorder.
With little literature on the treatment of opioid abuse and opioid use disorders in people with severe medical conditions, a team of researchers conducted a Delphi study to provide clinicians with evidence-based guidelines for the management and care of this patient population. The study is carried out asynchronously online and is based on the identification of participants with the relevant expertise.
The study researchers used a modified Delphi (RAND / UCLA Appropriateness Method.). [RAM]) Approach that aims to recruit at least 40 to 60 clinicians with experience in palliative care, addiction, or both to investigate the treatment of opioid abuse and opioid use disorder in patients with advanced cancer. The RAM panels used clinical scenarios and questions about the adequacy of various treatment and management techniques.
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To mimic potential challenges associated with treating patients with severe medical conditions who are prescribed opioid therapy, the study researchers created 7 patient cases. These included: “(1) inadequate pain control at the highest recommended dose of buprenorphine / naloxone, (2) inadequate pain control at a stable methadone dose, (3) prompt for early replenishment, (4) positive urine test for non-prescribed benzodiazepines, (5) positive urine test for cocaine or methamphetamine, (6) aggressive patient behavior in the clinic and (7) history of untreated OUD, which is currently not treated pharmacologically, with untreated pain. ”In any case, a series of questions about the appropriateness of different management strategies followed, which were rated using a 9-point Likert scale from the RAM.
After running modified Delphi panels, participants went through 3 rounds of data collection. In the first round, the participants rated and commented on the appropriateness of the management decisions for each of the cases. In the second round, they reviewed and discussed the numerical answers and comments from round 1. In the third round, which is currently running, the results of rounds 1 and 2 are discussed; However, participants are allowed to change their final numerical answers.
The study’s researchers used ExpertLens, the online program that runs the modified Delphi panels, to automatically determine whether the panels matched or not. You will only use the responses from the third round to assess the final panel consensus.
“The results of this modified Delphi study will help inform policy. This could include guidelines that address barriers to consensus strategies (e.g., the use of drugs for opioid use disorders such as increasing the availability of buprenorphine / naloxone in facilities where patients with severe illness are treated) on clinical, healthcare, national or dismantle the federal level, ”concluded the study authors.
reference
King C, Arnold R, Dao E, et al. Consensus-Based Approach to Treatment of Opioids, Including Opioid Abuse and Opioid Use Disorder, in Patients with Serious Illness: Protocol for a Modified Delphi Process. BMJ open. 2021; 11 (5): e045402. doi: 10.1136 / bmjopen-2020-045402
