Patient and Provider Differences in Patient Self-efficacy and Treatment of Opioid-Induced Constipation: A Content Analysis

Abstract

Introduction: Opioid-induced constipation (OIC) is one of many potential adverse effects resulting from opioid use. Although patients may develop tolerance to other side effects, they develop little to no tolerance of OIC, which can negatively affect quality of life. Approximately one third of patients report skipping, reducing doses, or terminating opioids to relieve OIC symptoms.To better understand the decision-making process for managing OIC, we assessed patient and provider treatment preferences, experiences, and communication regarding OIC and treatment options. Methods: We conducted 60-minute interviews with primary care providers and pain management specialists. We held two 90-minute focus groups with patients taking opioids for chronic pain. We used the qualitative analysis software Atlas.ti to code the transcripts for instances where informants discussed OIC, treatment preferences, and patient-provider communication about OIC. We used inductive methods to create the codes, grounding the codes in the data. We organized the codes under several overarching themes around OIC including: treatment experiences, attitudes towards treatments and patient-provider communication. We used quantitative content analysis to examine instances where providers and patients had different perspectives on OIC. Results: The two focus groups included 8 patients and we interviewed 6 providers. 83% of providers stated that OIC was a major concern but prioritized pain management over constipation. Providers focused on medication-based treatments, including laxatives, stool softeners, and peripherally acting mu opioid receptor antagonists (PAMORAs). Providers also mentioned strategies such as switching medications or lowering doses of opioids. 38% of patients mentioned taking an over-the-counter treatment, but most patients (63%) focused on diet-related OIC management (e.g. increasing fiber and water intake). 63% of patients stated that they did not receive adequate information from providers about OIC and relevant treatments. 38% of patients stated that they had OIC that was severe enough to warrant a visit to a gastroenterologist or the emergency department. Conclusion: Results from our analysis demonstrate that providers and patients have different preferences regarding the treatment of OIC; patients relied more heavily on diet-related treatments and providers preferred medication management of OIC. We found that 60% of patients wished they had more information on OIC and treatment options.