Development and validation of the Patient Opioid Education Measure

Lorraine S Wallace,1 Randell K Wexler,1 W Frederick Miser,1 Leon McDougle,1 J David Haddox2,3 1The Ohio State University, Department of Family Medicine, Columbus, OH, 2Purdue Pharma LP, One Stanford Forum, Stanford, CT, 3Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA Background: Although there are screening tools to aid clinicians in assessing the risk of opioid misuse, an instrument to assess opioid-related knowledge is not currently available. The purpose of this study was to develop a content-valid, understandable, readable, and reliable Patient Opioid Education Measure (POEM). Methods: Using concept mapping, clinicians caring for patients with chronic pain participated in brainstorming, sorting, and rating need-to-know information for patients prescribed opioids. Concept mapping analyses identified seven clusters addressing knowledge and expectations associated with opioid use, including medicolegal issues, prescribing policies, safe use and handling, expected outcomes, side effects, pharmacology, and warnings. Results: The 49-item POEM was verbally administered to 83 patients (average age 51.3 ± 9.8 years, 77.1% female, 47.1% African American) taking opioids for chronic nonmalignant pain. Patients averaged in total 63.9% ± 14.3% (range 23%–91%) correct responses on the POEM. The POEM demonstrated substantial test-retest reliability (interclass correlation coefficient 0.87). The POEM had a mean readability Lexile (L) score of 805.9 ± 257.3 L (equivalent to approximately a US fifth grade reading level), with individual items ranging from 280 L to 1370 L. Conclusion: The POEM shows promise for rapidly identifying patients' opioid-related knowledge gaps and expectations. Correcting misunderstandings and gaps could result in safer use of opioids in a clinical care setting. Keywords: opioid, knowledge, pain, questionnair

Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain

Lorraine S Wallace,1 Randell K Wexler,1 Leon McDougle,1 W Frederick Miser,1 J David Haddox2,3 1Department of Family Medicine, the Ohio State University, Columbus, OH, USA; 2Health Policy, Purdue Pharma L.P., Stamford, CT, USA; 3Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Background: Although psychometrically sound pain assessment tools are available, there is a paucity of research that comprehensively defines chronic pain from the perspective of patients. The purpose of this study was to examine the utility of a combination of qualitative methods (Photovoice, one-on-one interviews, and focus groups) in examining the daily experiences of primary care patients living with chronic pain. Methods: A sample of English-speaking primary care patients aged 30 years or older, who had been prescribed an opioid for long-term, noncancer pain management, participated in the study. Each patient took photographs that best reflected both his/her experiences with chronic pain and what he/she would like his/her life to be without chronic pain. Results: Patients submitted an average of 20.2±3.1 photographs (range =8–27 photographs). Analysis of one-on-one interviews illuminated five dominant themes: daily need for multiple medications, including opioids; difficulties climbing a flight of stairs; struggling to get out of bed in the morning; extreme challenges with participating in day-to-day life activities; and experiencing feelings of hopelessness and helplessness on a regular basis. Seven themes emerged from the focus groups: undesired effects/burdens of medications, loss of/striving for independence, effect on social interactions/relationships, pain effect on activities of daily living, constant search for convenience/a better situation, interactions with physicians, and frustration/depression with pain. Conclusion: The qualitative methods employed in this study provide deep insight into perceptions and experiences of patients living with chronic pain that is vital for informing future clinical interventions. Keywords: opioid, Photovoice, qualitative researc