Opioid-Induced Constipation: An Assessment of Clinical Practice Patterns and Barriers

Abstract

Introduction: The goal of this study was to assess physicians’ current knowledge, skills, competence, and practice barriers regarding the management of opioid induced constipation (OIC) and obtain a current snapshot of continuing medical education (CME) needs. Methods: A 24-question clinical practice assessment survey consisting of multiple-choice knowledge and casebased questions was made available to physicians who manage OIC in the United States without monetary compensation or charge The questions were designed to evaluate knowledge, skills, attitudes, and competence on OIC etiology, assessment, prevention, and treatment The survey launched online on a website dedicated to continuous professional development on November 17, 2017. Data were collected until December 12, 2017 Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses Results: 1351 Physicians (620 pain specialists, 207 gastroenterologists, and 524 PCPs) completed the survey during the study period. The key findings include: 11% of physicians were aware of the incidence of OIC 10% of physicians reported they were very confident in management of OIC 63% of physicians were aware of the etiology of OIC 35% of physicians were aware of the details of Rome IV criteria on OIC 39% of physicians were able to identify appropriate screening tools (eg, BFI) for constipation in patients receiving opioid therapy for pain 40% of physicians were able to identify FDA-approved treatments for OIC 43% of physicians were able to identify properties of peripherally acting μ-opioid receptor antagonists (PAMORAs) 38% of physicians were able to appropriately select evidence-based strategies for mitigating risk of OIC and formulate appropriate treatment plans for patients with OIC Top barriers reported were reluctance of patients to communicate regarding constipation (31%), not prescribing a stool softener/laxative at the same time as prescribing an opioid (31%), and lack of communication among clinicians (26%) Conclusion: This research yielded important insights into current gaps and barriers affecting clinical practice of physicians who manage OIC. Education on effective treatment strategies and patient communication regarding OIC are recommended to close the identified gaps<./p>