چکیده (انگلیسی):

Background:Primary care physicians struggle to treat chronic noncancer pain while limiting opioid misuse, abuse,
and diversion. The objective of this study was to understand how primary care physicians perceive their decisions
to prescribe opioids in the context of chronic noncancer pain management. This question is important because
interventions, such as decision support tools, must be designed based on a detailed understanding of how
clinicians use information to make care decisions.
Methods:We conducted in-depth qualitative interviews with family medicine and general internal medicine
physicians until reaching saturation in emergent themes. We used a funneling approach to ask a series of questions
about physicians’ general decision making challenges and use of information when considering chronic opioids.
We then used an iterative, open-coding approach to identify and characterize themes in the data.
Results:We interviewed fifteen physicians with diverse clinical experiences, demographics, and practice affiliations.
Physicians said that general decision making challenges in providing pain management included weighing risks
and benefits of opioid therapies and time and resource constraints. Also, some physicians described their active
avoidance of chronic pain treatment due to concerns about opioid risks. In their decision making, physicians
described the importance of objective and consistent information, the importance of identifying“red flags” related
to risks of opioids, the importance of information about physical function as an outcome, and the importance of
information that engenders trust in patients.
Conclusions:This study identified and described primary care physicians’ struggles to deliver high quality care as they
seek and make decisions based on an array of incomplete, conflicting, and often untrusted patient information.
Decision support systems, education, and other interventions that address these challenges may alleviate primary care
physicians’ struggles and improve outcomes for patients with chronic pain and other challenging conditions.