PMID- 33948790
OWN - NLM
STAT- MEDLINE
DCOM- 20210805
LR  - 20220716
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 36
IP  - 7
DP  - 2021 Jul
TI  - Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid 
      Prescribing for Cancer: a Qualitative Study.
PG  - 1867-1874
LID - 10.1007/s11606-021-06747-z [doi]
AB  - BACKGROUND: Cancer pain is highly prevalent and often managed in primary care or 
      by oncology providers in combination with primary care providers. OBJECTIVES: To 
      understand interdisciplinary provider experiences coordinating opioid pain 
      management for patients with chronic cancer-related pain in a large integrated 
      healthcare system. DESIGN: Qualitative research. PARTICIPANTS: We conducted 20 
      semi-structured interviews with interdisciplinary providers in two large 
      academically affiliated VA Medical Centers and their associated community-based 
      outpatient clinics. Participants included primary care providers (PCPs) and 
      oncology-based personnel (OBPs). APPROACH: We deductively identified 94 examples 
      of care coordination for cancer pain in the 20 interviews. We secondarily used an 
      inductive open coding approach and identified themes through constant comparison 
      coming to research team consensus. RESULTS: Theme 1: PCPs and OBPs generally 
      believed one provider should handle all opioid prescribing for a specific 
      patient, but did not always agree on who that prescriber should be in the context 
      of cancer pain. Theme 2: There are special circumstances where having multiple 
      prescribers is appropriate (e.g., a pain crisis). Theme 3: A collaborative 
      process to opioid cancer pain management would include real-time communication 
      and negotiation between PCPs and oncology around who will handle opioid 
      prescribing. Theme 4: Providers identified multiple barriers in coordinating 
      cancer pain management across disciplines. CONCLUSIONS: Our findings highlight 
      how real-time negotiation about roles in opioid pain management is needed between 
      interdisciplinary clinicians. Lack of cross-disciplinary role agreement may 
      result in delays in clinically appropriate cancer pain management.
CI  - (c) 2021. This is a U.S. government work and not under copyright protection in the 
      U.S.; foreign copyright protection may apply.
FAU - Giannitrapani, K F
AU  - Giannitrapani KF
AUID- ORCID: 0000-0003-0987-6204
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA. Karleen@stanford.edu.
AD  - Division of Primary Care and Population Health, Stanford University School of 
      Medicine, Stanford, CA, USA. Karleen@stanford.edu.
FAU - Silveira, M J
AU  - Silveira MJ
AD  - Geriatric Research Education Clinical Center (GRECC), Ann Arbor VA Health Care 
      System, University of Michigan, Ann Arbor, MI, USA.
AD  - Division of Geriatric and Palliative Medicine, Department of Internal Medicine, 
      University of Michigan, Ann Arbor, MI, USA.
FAU - Azarfar, A
AU  - Azarfar A
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA.
AD  - University of Central Florida, Orlando, FL, USA.
FAU - Glassman, P A
AU  - Glassman PA
AD  - Pharmacy Benefits Management Services, Department of Veterans Affairs, 
      Washington, DC, USA.
AD  - Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 
      USA.
FAU - Singer, S J
AU  - Singer SJ
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA.
AD  - Division of Primary Care and Population Health, Stanford University School of 
      Medicine, Stanford, CA, USA.
FAU - Asch, S M
AU  - Asch SM
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA.
AD  - Division of Primary Care and Population Health, Stanford University School of 
      Medicine, Stanford, CA, USA.
FAU - Midboe, A M
AU  - Midboe AM
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA.
FAU - Zenoni, M A
AU  - Zenoni MA
AD  - Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA 
      Connecticut Health Care System, West Haven, CT, USA.
AD  - Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
FAU - Gamboa, R C
AU  - Gamboa RC
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA.
FAU - Becker, W C
AU  - Becker WC
AD  - Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA 
      Connecticut Health Care System, West Haven, CT, USA.
AD  - Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
FAU - Lorenz, K A
AU  - Lorenz KA
AD  - Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 
      Menlo Park, CA, USA.
AD  - Division of Primary Care and Population Health, Stanford University School of 
      Medicine, Stanford, CA, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20210504
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Analgesics, Opioid
MH  - Attitude of Health Personnel
MH  - *Chronic Pain/drug therapy/etiology
MH  - Humans
MH  - *Neoplasms/complications/epidemiology
MH  - Practice Patterns, Physicians'
MH  - Qualitative Research
PMC - PMC8298631
OTO - NOTNLM
OT  - cancer
OT  - opioids
OT  - pain
OT  - qualitative research
OT  - veterans
COIS- All of the authors report grants from Department of Veterans Affairs during the 
      conduct of the study. Dr. Glassman reports nonfinancial support from U.S. 
      Pharmacopeia as well as nonfinancial support and others from the Food and Drug 
      Administration, outside the submitted work. All other authors declare that they 
      do not have a conflict of interest. This work represents solely the perspectives 
      of the authors and does not reflect the opinions of the authors' affiliated 
      universities, the Department of Veterans Affairs, or the US Government.
EDAT- 2021/05/06 06:00
MHDA- 2021/08/06 06:00
PMCR- 2022/07/01
CRDT- 2021/05/05 06:36
PHST- 2020/02/24 00:00 [received]
PHST- 2021/03/18 00:00 [accepted]
PHST- 2021/05/06 06:00 [pubmed]
PHST- 2021/08/06 06:00 [medline]
PHST- 2021/05/05 06:36 [entrez]
PHST- 2022/07/01 00:00 [pmc-release]
AID - 10.1007/s11606-021-06747-z [pii]
AID - 6747 [pii]
AID - 10.1007/s11606-021-06747-z [doi]
PST - ppublish
SO  - J Gen Intern Med. 2021 Jul;36(7):1867-1874. doi: 10.1007/s11606-021-06747-z. Epub 
      2021 May 4.