Expectation-setting and patient education about pain control in the perioperative setting: A qualitative study

Josh Bleicher, MD, MS; Jordan Esplin, BS; Allison N. Blumling, MS; Jessica N. Cohan, MD, MAS; Mark Savarise, MD, MBA, FACS; David W. Wetter, PhD; Alex H.S. Harris, PhD, MS; Kimberly A. Kaphingst, ScD; Lyen C. Huang, MD, MPH, FACS

doi:10.5055/jom.2021.0680

Authors

Josh Bleicher, MD, MS
Jordan Esplin, BS
Allison N. Blumling, MS
Jessica N. Cohan, MD, MAS
Mark Savarise, MD, MBA, FACS
David W. Wetter, PhD
Alex H.S. Harris, PhD, MS
Kimberly A. Kaphingst, ScD
Lyen C. Huang, MD, MPH, FACS

DOI:

https://doi.org/10.5055/jom.2021.0680

Keywords:

patient expectations, patient education, opioid stewardship, pain management, qualitative methods

Abstract

Objective: Interventions aimed at limiting opioid use are widespread. These are most often targeted toward prescribers or health systems. Patients’ perspectives are too often absent during the creation of such interventions. This qualitative study aims to understand patient experiences with education about perioperative pain control, from preoperative expectation-setting to post-operative pain control strategies and ultimately opioid disposal.

Design: We performed semistructured interviews focused on patient experiences in the perioperative period. Content from interview transcripts was analyzed using a constant comparative method.

Setting: All participants underwent surgery at a single, academic tertiary-care center.

Participants: Adult patients who had a general surgery operation in the prior 60 days.

Outcome measure: Key themes from interviews about perioperative pain management, specifically related to preoperative expectation-setting and post-operative education.

Results: Patients identified gaps in communication and education in three main areas: preoperative expectation setting of post-operative pain; post-operative pain control strategies, including use of opioid medications; and the importance of appropriate opioid disposal. Failure to set expectations led to either significant patient anxiety preoperatively or poor preparation for home discharge. Poor education on pain control strategies led to misinformation on when and how to use opioids. Lack of education on opioid disposal led to most participants failing to properly dispose of leftover medication.

Conclusions: Gaps in education surrounding post-operative pain and opioid use can lead to patient anxiety, inappropriate use of opioids, and poor disposal rates of leftover medications. Future interventions aimed at patient education to improve pain management and opioid stewardship should be created with an understanding of patient experiences and perceptions.

Author Biographies

Josh Bleicher, MD, MS

Department of Surgery, University of Utah, Salt Lake City, Utah

Jordan Esplin, BS

Department of Surgery, University of Utah, Salt Lake City, Utah

Allison N. Blumling, MS

Department of Communication, University of Utah, Salt Lake City, Utah

Jessica N. Cohan, MD, MAS

Department of Surgery, University of Utah; Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah

Mark Savarise, MD, MBA, FACS

Department of Surgery, University of Utah, Salt Lake City, Utah

David W. Wetter, PhD

Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah

Alex H.S. Harris, PhD, MS

Department of Surgery, Stanford University, Stanford; Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California

Kimberly A. Kaphingst, ScD

Department of Communication, University of Utah; Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah

Lyen C. Huang, MD, MPH, FACS

Department of Surgery, University of Utah; Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah

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