Opportunities to Improve Prescription Opioid Management in Advanced Cancer: A Concept Mapping Approach to Intervention Development

Moderate-to-severe cancer pain is frequently managed with prescription opioids. However, there are many barriers to guideline-concordant prescription opioid management, including stigma surrounding prescription opioids. The goal of this concept mapping study was to work directly with patients to identify actionable treatment targets to inform future behavioral intervention development that can ultimately improve cancer pain management. Investigators were particularly interested in exploring patient perspectives on opioid stigma interventions, given the lack of existing strategies in this area. Investigators conducted concept mapping with 20 patients with advanced cancer pain who endorsed at least one aspect of opioid stigma. Participants responded to a broad focal prompt: "What kinds of supports and problems should people know about when using prescription opioids to treat cancer pain?" Findings revealed 5 "clusters": 1) pain and opioid management; 2) prescription opioid stigma; 3) clinician attitudes about prescription opioids; 4) support and resources; and 5) insurance and pharmacy issues. Salient discussion focused on strategies to improve internalized stigma and reducing stigmatizing clinician attitudes. Future research should develop and test easily accessible multicomponent, contact-based, and/or internalized stigma interventions that integrate psychoeducation and shared decision-making. PERSPECTIVE: This article presents important, actionable intervention targets for improving cancer pain management, with a specific emphasis on addressing opioid stigma. Findings can be used to inform future intervention development efforts that improve patient and clinician skills, including multicomponent, contact-based, and/or internalized stigma interventions, improved psychoeducation, and shared decision-making.