Abstract
Background and objectives: Long-term opioid prescriptions for post-operative pain management pose a significant risk for subsequent opioid dependence. This study addressed two key objectives: to assess the effectiveness of interventions in reducing opioid use after surgery and to identify the behaviour change techniques (BCTs) employed in these interventions.
Methods: A structured search strategy encompassing databases including Medline, Embase, CINAHL Plus, PsycINFO, and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting opioid reduction in adults following major surgeries. The risk of bias was evaluated using RoB-2 and ROBINS-I tools, and Cohen's d effect sizes were calculated. BCTs were identified using a validated taxonomy.
Results: Twenty-two studies, comprising 7 clinical trials and 15 cohort studies, were included, with varying risks of bias. Educational (n=12), guideline-focused (n=3), multifaceted (n=5), and pharmacist-led (n=2) interventions demonstrated diverse effect sizes (small-medium n=10, large n=12). A total of 23 unique BCTs were identified across studies, occurring 140 times. No significant association was observed between the number of BCTs and effect size, and
interventions with large effect sizes predominantly targeted healthcare professionals. Key BCTs in interventions with the largest effect sizes included behaviour instructions, behaviour substitution, goal setting (outcome), social support (practical), social support (unspecified), pharmacological support, prompts/cues, feedback on behaviour, environmental modification, graded tasks, outcome goal review, health consequences information, action planning, social comparison, credible source, outcome feedback, and social reward.
Conclusions: Understanding the dominant BCTs in highly effective interventions provides
valuable insights for future opioid tapering strategy implementations. Further research and validation are necessary to establish associations between BCTs and effectiveness, considering additional influencing factors.
Methods: A structured search strategy encompassing databases including Medline, Embase, CINAHL Plus, PsycINFO, and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting opioid reduction in adults following major surgeries. The risk of bias was evaluated using RoB-2 and ROBINS-I tools, and Cohen's d effect sizes were calculated. BCTs were identified using a validated taxonomy.
Results: Twenty-two studies, comprising 7 clinical trials and 15 cohort studies, were included, with varying risks of bias. Educational (n=12), guideline-focused (n=3), multifaceted (n=5), and pharmacist-led (n=2) interventions demonstrated diverse effect sizes (small-medium n=10, large n=12). A total of 23 unique BCTs were identified across studies, occurring 140 times. No significant association was observed between the number of BCTs and effect size, and
interventions with large effect sizes predominantly targeted healthcare professionals. Key BCTs in interventions with the largest effect sizes included behaviour instructions, behaviour substitution, goal setting (outcome), social support (practical), social support (unspecified), pharmacological support, prompts/cues, feedback on behaviour, environmental modification, graded tasks, outcome goal review, health consequences information, action planning, social comparison, credible source, outcome feedback, and social reward.
Conclusions: Understanding the dominant BCTs in highly effective interventions provides
valuable insights for future opioid tapering strategy implementations. Further research and validation are necessary to establish associations between BCTs and effectiveness, considering additional influencing factors.
| Original language | English |
|---|---|
| Journal | BMJ Quality and Safety |
| Publication status | Published - 12 Jul 2024 |
Keywords
- Surgery
- Patient safety
- Healthcare quality improvement