Edward R. Mariano, MD, MAS
Chief, Anesthesiology and Perioperative Care
Associate Chief of Staff for Inpatient Surgical
VA Palo Alto Health Care System
Professor of Anesthesiology, Perioperative and
Stanford University School of Medicine
Palo Alto, CA 94304
PainRelief.com: What is the
background for this study? What are the
Response: Today, there is so much attention on the opioid
epidemic, and patients and clinicians are constantly reminded about the dangers
of opioids. Guidelines have recommended the provision of patient and caregiver
education on pain management, especially on how to taper (safely decrease and
eventually stop taking) opioids after surgery. With over 70 fellowship programs
in regional anesthesiology and acute pain medicine, we assumed that there would
be plenty of information for patients on safe opioid management online since
most people use the internet to find health-related information. We conducted a
rigorous search for online patient education materials related to safe opioid
management, evaluated to reading level and content, and compared materials
produced by fellowship programs to other online educational materials.
Unfortunately, the average reading level for all materials we found was above
the level recommended for patients (sixth grade or lower). Most fellowship
programs in regional anesthesiology and acute pain medicine did not even offer
online patient education materials and were less likely to describe overdose
risk and opioid disposal. Less than half of all materials mentioned tapering or
cessation of opioids after surgery (see visual abstract attached).
PainRelief.com: What should readers take away from your report?
Response: Since our patients reliably go to the internet for information, we as a healthcare community need to get out there and put valuable information online that people can use. Overdoses due to opioids are a public health crisis, and direct-to-patient education on safe opioid storage, tapering, and disposal through the internet can make a difference. Fellowship programs should take the lead. As the institutions training the next generation of physician leaders in regional anesthesiology and acute pain medicine, one priority should be teaching fellows modern communication tools to help educate their patients and society in general.
PainRelief.com: What recommendations do you have for future research as
a result of this work?
Response: For this study, we focused on written materials
only in order to assess readability, but we do not yet know what is the ideal
format (e.g., video) for providing patient education. This preference may be
influenced by a number of factors and should be studied. We also do not know
the best location for patient educational materials online or how to most
efficiently disseminate this information to people likely to benefit from it.
Another important research question is when and how patients access information
related to their own care as this may influence when to promote online
educational materials to patients preparing for surgery.
PainRelief.com: Is there anything else you would like to add?
Response: None of the authors has financial conflicts of
interest to disclose. I currently serve on the Board of Directors for the
American Society of Regional Anesthesia and Pain Medicine (ASRA), Chair of the
Committee on Regional Anesthesia and Acute Pain Medicine for the American
Society of Anesthesiologists (ASA), Speaker of the House of Delegates for the
California Society of Anesthesiologists, and National Academy of Medicine
Action Collaborative Countering the U.S. Opioid Epidemic.
Gunjan Kumar, Kellie M Jaremko, Alex Kou,
Steven K Howard, T Kyle Harrison, Edward R Mariano; Quality of Patient
Education Materials on Safe Opioid Management in the Acute Perioperative
Period: What Do Patients Find Online?, Pain Medicine, , pny296, https://doi.org/10.1093/pm/pny296
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