Educating Patients Regarding Pain Management and Safe Opioid Use After Surgery

A Narrative Review

Bradley H. Lee, MD; Christopher L. Wu, MD

Disclosures

Anesth Analg. 2020;130(3):574-581. 

In This Article

Approaches to Educational Interventions

In terms of educational interventions, a wide range of methods have been evaluated and found to be effective with distinct advantages and limitations of each method (see Table 2).

Information provided in written formats has traditionally been used to educate patients. Pamphlets and booklets, for example, have demonstrated efficacy for educating patients.[18,75] This form of information can be easily distributed and may be referenced as needed. Though written information is commonly used, unfortunately it does not allow confirmation of understanding or addresses potential questions that patients might have. Patients also have varying degrees of reading comprehension which can be problematic, and written formats may not be the preferred mode for certain patients due to some of these factors.[76]

Videos do not rely on reading comprehension and are effective for providing information. For example, patients who viewed an informational video before elective surgery under regional anesthesia experienced less anxiety, and this effect was extended into the postoperative period, as well.[77] Video information provided to patients preoperatively also resulted in lower levels of anxiety in those undergoing procedures such as colonoscopy and hip and knee arthroplasty.[78,79] To prevent opioid overdose deaths, the Veterans Health Administration (VHA) developed a program for educating providers and patients that included videos as part of the training.[80] A significant number of successful overdose reversals were reported after the implementation of this educational program.[80] Chakravarthy et al[81] found that acquisition of information regarding opioid risks and safe usage was improved in those who viewed an animated video. Similar to written formats, however, video does not provide opportunity to address questions that patients might have.

Web-based strategies can combine audio, visual, and written information. Audio and visual aids might address low literacy barriers and interactive learning has demonstrated efficacy in acquiring and retaining knowledge.[82,83] Further benefits of web-based interventions include ability to update information, ease of dissemination, and ability to provide feedback and assess knowledge.[28] In a study by McCauley et al,[28] a web-based tool written at a sixth-grade reading level using multimedia format was used to teach patients about opioid misuse and how to safely use, store, and dispose of prescription opioids. Patients demonstrated improved knowledge including where to store pills and how to dispose of medications, and the intervention also resulted in lower reported rates of lending pills, borrowing pills, and saving unused medications.[28]

Some educators believe that live and in-person teaching is important because it provides a way to confirm understanding and answer questions. There is some evidence that verbal communication combined with written information may be more effective than the written format alone.[84] Multidisciplinary information sessions involving providers and small groups of patients have demonstrated efficacy in reducing anxiety and pain associated with total hip arthroplasty.[85] By having a group session, it allows multiple patients to receive education simultaneously and is more efficient and cost-effective. Another advantage is the benefit of hearing answers to questions from other participants. The main barriers to in-person education, however, are the time constraints and limited availability of providers.

Regarding the timing of education, teaching patients before surgery and hospitalization may confer advantages in cost by improving recovery and requiring fewer postoperative services such as occupational and physiotherapy.[86] There is also evidence that education may be more effective in providing knowledge and potentially affecting outcomes when it is done preoperatively.[87] Unfortunately, information is often provided after surgery when patients are recovering from anesthesia and have received a number of sedating medications, and knowledge retention may be difficult in such stages of care.

The delivery of educational material is likely most effective as a collaborative effort among providers. Surgeons see patients before surgery and may therefore be in a position to provide informational brochures and pamphlets to patients. Information can be reiterated during presurgical visits, and there may be opportunity to address questions by both surgeons and anesthesiologists preoperatively. Anesthesiologists can clarify concepts of regional anesthesia and further explain strategies of multimodal analgesia and pain management. Nursing staff are also able to provide additional instruction after surgery and before discharge. The role of patient education is also well-suited for the emerging concept of the perioperative surgical home where patients are seen throughout the perioperative period.[88] Along these lines, the role of education is probably best handled as a combined effort among primary care physicians, surgeons, anesthesiologists, and other specialists.

It may also be useful to confirm or assess how well patients comprehend the information that they have received as delivering information is more effective when appropriately understood. There is no uniform method of evaluating patient knowledge, and this can be done in various ways. It may be as simple as having a patient verbalize key points to confirm their understanding. Patients can also be asked questions and evaluated based on their responses to see how well they comprehend and retain information. For practical purposes, this may involve reviewing only key concepts and providing resources as references for more straightforward details.

Finally, we have reviewed pain management and opioid use after surgery with the understanding that educational needs of each patient are highly variable and depend on the patient's background, history of substance abuse, type of procedure, and many other factors. Each patient has characteristics that lead to different experiences related to pain control and risks of opioid misuse and abuse, and ideally, the information and means of providing it are tailored as much as possible to each individual.

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