"They Ask Questions, But They Don't Want the Answers"-Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder.

Publisher: Sage Publishing Country of Publication: United States NLM ID: 9918750589006676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2976-7350 (Electronic) Linking ISSN: 29767342 NLM ISO Abbreviation: Subst Use Addctn J Subsets: MEDLINE

Original Publication: Thousand Oaks, California : Sage Publishing, [2024]-

Buprenorphine*/therapeutic use ; Buprenorphine*/administration & dosage ; Opioid-Related Disorders*/drug therapy ; Opioid-Related Disorders*/psychology ; Veterans*/psychology ; Communication*; Humans ; Male ; Female ; Middle Aged ; Adult ; Aged ; Opiate Substitution Treatment/psychology ; Retrospective Studies ; Analgesics, Opioid/therapeutic use ; Analgesics, Opioid/administration & dosage ; United States

Background: Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be practiced less frequently in the context of OUD care. Patient-provider communication can influence patients' care experiences, potentially having an impact on treatment retention and care decision-making.
Methods: This study was conducted at the VA Portland Health Care System from March 2021 to April 2022. We conducted qualitive interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past year. Coding and analysis were guided by inductive qualitative content analysis. Retrospective medical record review identified clinical and demographic characteristics of participants.
Results: Twenty patients completed an interview. Participant age ranged from 28 to 74 years (median 63 years). Ninety percent of participants were white and 90% male. Many participants expressed frustration and feelings of disempowerment in OUD care processes. Patients with a history of long-term prescribed opioid use frequently expressed stigmatizing views of OUD, and perceptions of disagreement with providers over diagnosis and care choices. Elderly patients and those with multiple comorbidities expressed confusion over significant aspects of their care, as well as difficulty navigating treatment logistics like appointment requirements and medication dose changes. Some patients reported later restarting buprenorphine in new settings, and described feeling respected and involved in care decisions as a facilitator for continuing treatment.
Conclusions: Prioritizing patient-centered communication in OUD treatment could improve the patient experience and potentially support treatment retention. Subgroups of OUD patients, such as those with a history of long-term prescribed opioid use, elderly patients with multiple comorbidities, or those who express stigmatizing medication views, could particularly benefit from tailored communication strategies that address their individual concerns.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

J Subst Abuse Treat. 2017 Feb;73:47-54. (PMID: 28017184)
Psychiatr Serv. 2020 Jan 1;71(1):35-42. (PMID: 31500544)
Circ Cardiovasc Qual Outcomes. 2017 Sep;10(9):. (PMID: 28830861)
J Am Psychiatr Nurses Assoc. 2022 Jan-Feb;28(1):9-22. (PMID: 34791954)
Nurse Educ Today. 2017 Sep;56:29-34. (PMID: 28651100)
Behav Cogn Psychother. 2011 May;39(3):257-71. (PMID: 21489349)
Int J Qual Health Care. 2007 Dec;19(6):349-57. (PMID: 17872937)
Ann Intern Med. 2018 Aug 7;169(3):137-145. (PMID: 29913516)
Subst Abuse. 2022 Jun 27;16:11782218221103859. (PMID: 35783464)
J Subst Abuse Treat. 2018 Dec;95:9-17. (PMID: 30352671)
J Pain. 2017 Nov;18(11):1365-1373. (PMID: 28690000)
J Addict Med. 2024 May-Jun 01;18(3):300-305. (PMID: 38498620)
Addict Sci Clin Pract. 2023 Feb 11;18(1):10. (PMID: 36774521)
J Subst Abuse Treat. 2021 Dec;131:108548. (PMID: 34244013)
Subst Use Misuse. 2016 May 11;51(6):763-76. (PMID: 27096889)
Subst Abuse Treat Prev Policy. 2020 Jan 20;15(1):7. (PMID: 31959189)
Drug Alcohol Depend. 2023 Aug 1;249:110873. (PMID: 37390780)
Subst Abus. 2023 Jan-Apr;44(1):41-50. (PMID: 37226910)
JAMA Netw Open. 2020 Feb 5;3(2):e1920622. (PMID: 32022884)
JAMA. 2014 Apr 9;311(14):1393-4. (PMID: 24577059)
PLoS Med. 2019 Nov 26;16(11):e1002969. (PMID: 31770387)
Diabetes Res Clin Pract. 2017 May;127:265-274. (PMID: 28407552)
J Psychoactive Drugs. 2011 Apr-Jun;43(2):99-107. (PMID: 21858956)
Subst Use Misuse. 2018 Jan 28;53(2):330-333. (PMID: 28961017)
Qual Health Res. 2005 Nov;15(9):1277-88. (PMID: 16204405)
Can J Pain. 2021 Apr 15;5(1):66-80. (PMID: 34189391)
J Patient Cent Res Rev. 2022 Oct 18;9(4):253-262. (PMID: 36340571)
Clin J Oncol Nurs. 2019 Oct 1;23(5):540-542. (PMID: 31538972)
Drug Alcohol Depend. 2013 Jul 1;131(1-2):23-35. (PMID: 23490450)
J Gen Intern Med. 2019 Jul;34(7):1200-1206. (PMID: 31011964)
Ann Fam Med. 2011 Mar-Apr;9(2):100-3. (PMID: 21403134)
J Subst Abuse Treat. 2015 Oct;57:75-80. (PMID: 25997674)
Health Commun. 2020 Sep;35(10):1239-1247. (PMID: 31179769)
JAMA Pediatr. 2018 Nov 1;172(11):1029-1037. (PMID: 30208470)
J Subst Abuse Treat. 2023 Jan;144:108918. (PMID: 36403456)
Psychother Psychosom. 2009;78(4):245-53. (PMID: 19468259)
J Subst Abuse Treat. 2022 Apr;135:108646. (PMID: 34810044)
J Subst Abuse Treat. 2020 Nov;118:108125. (PMID: 32972650)
Nurs Res Pract. 2011;2011:672474. (PMID: 21994839)
Patient Educ Couns. 2017 Apr;100(4):696-702. (PMID: 27916463)

IK2 HX003007 United States HX HSRD VA

Keywords: buprenorphine; communication; decision-making; opioid-related disorders; patient-centered care

40D3SCR4GZ (Buprenorphine)
0 (Analgesics, Opioid)

Date Created: 20240520 Date Completed: 20241007 Latest Revision: 20241009

20241009

PMC11458360

10.1177/29767342241251761

38767274