A qualitative study to develop materials educating patients about opioid use before and after total hip or total knee arthroplasty

Abstract

Objective: The authors undertook a qualitative study with open-ended, structured interviews to understand patient's educational needs for patients undergoing total hip and total knee arthroplasty (THA/TKA).

Design: Provider interviews explored their approach with THA/TKA patients on: pain management; barriers to opioid tapering; and recommendations/changes on educational materials to support pain management and opioid reduction. Patient interviews explored their experience, understanding, beliefs surrounding opioids, and recommendations on important content. A qualitative methodologist conducted interviews and content analysis to identify key themes.

Setting: Kaiser Permanente Northwest, community setting.

Patients, Participants: A purposeful sampling method identified interviewees (surgeons, advice nurses, physical therapists, physician assistants, and patients). Patients were recent THA/TKA cases in the top third of opioid use after surgery.

Interventions: N/A.

Main Outcome Measure(s): Qualitative study.

Results: Recommendations for patient educational content included: (1) clear descriptions of how opioids work in the body, how to taper, nonopioid pain management options, and problems from overuse; (2) messaging on how long to expect to use opioids and type of pain to expect; (3) visual timeline to illustrate opioid tapering and exercise expectations; (4) emphasize that pain management is multimodal, and stress the balance between opioids for recovery versus overuse; (5) provide educational messaging multiple times prior to and after surgery.

Conclusions: Patients and providers agreed that clearly stated verbal and written messaging is needed beyond what has typically been done regarding opioid expectations.