Determining the Feasibility and Utility of Risk Assessment in Opioid-Treated Patients with Cancer at an Outpatient Palliative Care Clinic (QI806)

Abstract

•Discuss the feasibility of opioid risk screening in an outpatient palliative care oncology clinic.•Quantify the capacity of opioid risk screening tools to provide results that influence prescribing decisions in an outpatient clinic setting. Opioid risk screening tools may facilitate safer opioid prescribing by identifying patients at the highest risk for opioid abuse, misuse and diversion. However, it is unclear if these tools actually influence prescribing decisions. To increase the prevalence of opioid risk screening for palliative care outpatients receiving chronic opioid therapy and to assess if screening results influence clinicians' prescribing decisions. A student pharmacist attended clinic one afternoon per week to screen all patients prescribed chronic opioid therapy using the Opioid Risk Tool (ORT) and the Screener for Opioid Assessment for Patients with Pain-Short Form (SOAPP-SF). Then, a palliative care clinician conducted a routine office visit. Finally, the student pharmacist shared screening results with the clinician, who reported if results impacted prescribing decisions. 30 patients were screened in total; 70% were male, 86.7% were white, and the mean age was 54.6 years old. 23.3% of patients had colorectal cancer; a variety of other cancers were represented. 30% of patients scored positive on the SOAPP-SF, and 20% of patients scored high risk on the ORT. Prescribing decisions were changed for 33.3% of patients; the most common prescribing decision among high risk patients was to keep the opioid dose the same. The results from this quality improvement project demonstrate that formal risk screening may impact prescribing patterns in an outpatient palliative care oncology clinic, suggesting that formal screening protocols may be beneficial for clinicians when prescribing chronic opioids. In addition, this strategy may reduce the amount of opioids prescribed to patients at highest risk for opioid abuse, misuse, and diversion, thereby protecting patients and communities. Further research is needed to determine the most effective and least burdensome strategy for incorporating formal risk screening into standard practice.