Shared Decision Making Reduces Post-Hysterectomy Opioid Prescribing

Deaths from drug overdose continue to rise in the United States. In 2017, every 15 people per 100,000 died from an opioid overdose.¹ That is 12 more per 100,000 people than in 1999. It is more important than ever before that the health care community joins efforts to control this epidemic better.

Shared decision making is a tool used by health care professionals to educate more thoroughly, and communicate with their patients. The 2 parties share information and come to an agreement in terms of a treatment regimen. The patient has a chance to express his or her needs and concerns.

Obstetrics & Gynecology (The Green Journal) published a recent study confirming that shared decision making between the provider and the patient greatly reduced opioid prescribing.² In the preoperative holding area, the researchers showed patients about to undergo hysterectomies a visual aid. The visual aid provided the patient with information regarding pain expectations after surgery, the risks of opioid use, and possible adverse effects. The back of the visual aid depicted a scale of the number of tablets often prescribed after a hysterectomy. The scale ranged from the average number of tablets prescribed to the maximum number of tablets prescribed.

The researchers at the University of Michigan conducted a quality initiative study with a sample size of 204 patients. All study participants had hysterectomies for benign indications. Applying shared decision making, the prescriber and the patient openly discussed the patient’s pain management.

The prescriber shared the visual aid and guidance in opioid use, and the patient shared her thoughts and preferences. Ultimately, the patient went home with a number of tablets that was agreed upon by both parties.

The study found that patients who participated in the visual aid education were prescribed significantly fewer opioid equivalents than the patients who did not. Even so, most patients reported having leftover tablets, yet were satisfied with their pain management.

Put into clinical perspective, researchers see an emerging role for shared decision making in combating the opioid epidemic effectively. For future research, the effects of leftover opioids on illegal consumption may be promising. About 75% of the patients in this study reported having leftover tablets, but many did not know what to do with them.

To prevent leftover tablets from falling into the hands of unintended individuals, further research may be required. Duration of use is a significant indicator in total use. Assessing and reducing duration may be a tool in understanding the opioid crisis, and possibly reducing total use.

Julia A. Adams is a 2021 PharmD Candidate at the University of Connecticut in Storrs.

REFERENCES

• Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999—2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. 2018.
• Vilkins A, Sahara M, Till S, et al. Effects of shared decision making on opioid prescribing after hysterectomy. Obstetrics & Gynecology. 2019;134(4):823.