P-075 - Empowering orthopaedic patients: a patient-centred approach to optimising postoperative analgesic education.

Abstract Title: Empowering orthopaedic patients: a patient-centred approach to optimising postoperative analgesic education.

Background: Escalating opioid use globally has led to the concept of opioid and analgesic stewardship, particularly in hospital settings.¹ Stewardship programs aim to promote and support appropriate analgesic use, particularly with opioids, to treat pain whilst minimising harm. Whilst there is no consensus on how these programs should be designed, it is widely recognised that education for patients is an important component.^1-3 Additionally, patients express a strong need for education, including regarding analgesic use, to empower them to self-manage their pain, particularly following surgery.⁴ The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) partnership group recently published recommendations for involving patients in pain research design.⁵ They emphasise the need to develop meaningful relationships with patients, involving them throughout the research process given the subjectivity of the pain experience. Despite this recognised need, active patient contribution to pain research is limited.⁵ Postoperative analgesic education research to date has primarily aimed to reduce opioid prescribing and consumption with less focus on patient-centred outcomes, such as patient satisfaction and self-efficacy.⁶ Furthermore, factors that may influence the impact of education for patients, both positively and negatively (such as health literacy), have not been extensively explored.

Purpose/Objectives: This multi-study research seeks to address this research gap by developing a patient informed analgesic education intervention that will improve patient-centred outcomes following orthopaedic surgery. Initially, patients and healthcare professionals will be surveyed to explore their experience, knowledge and/or perception of postoperative pain management education that is currently given as standard care (study 1 and 2). Results from these studies will then be collated for the development of the final analgesic education intervention that will subsequently be evaluated prospectively in a patient cohort undergoing orthopaedic surgery (study 3).


Methods: Study 1

Orthopaedic patients will be surveyed within ten days of hospital discharge to understand their views on the analgesic education they received and recommendations on how this type of education should be delivered.



Study 2:

Patient survey results will inform a Delphi study of healthcare providers and patient advocates, where analgesic education topics will be ranked for importance on a Likert scale. Topics will include education content, delivery methods, and outcomes for evaluating effectiveness. At least two rounds will be conducted, with a third round added if new topics arise during the first round and consensus in not reached after the second round.



Study 3

Studies 1 and 2 will inform the development of an analgesic education intervention, piloted in a prospective pre-post trial. Eligible adult patients will undergo open orthopaedic surgery and receive standard care (pre-intervention group) or the intervention (post-intervention group). Patient surveys will be conducted at 1-, 6-, and 12-weeks following discharge to evaluate effectiveness. A range of patient-centred outcomes will be measured, including pain and functional scores, analgesic use and side-effects, satisfaction, self-efficacy, empowerment and engagement with pain management strategies and activities. Additional outcomes identified in the preceding studies will be included where appropriate.


Results: The expected outcomes from this research include:

1. There will be a difference in the current standard of education provided to patients regarding analgesic management following orthopaedic surgery and the education patients want to receive.


2. The Delphi panel will recommend specific content and design method considerations, as well as outcomes for evaluting the effectiveness of education.


3. The level of agreement will be high between the Delphi panel and patient cohort regarding the recommendations for designing and evaluating analgesic-based education.


4. Patients who receive the analgesic-based education intervention will perceive their ability and self-efficacy to manage postoperative pain as more able, compared to patients who did not receive the intervention.

Conclusions/Implications for future research and/or clinical care: The traditional paternalistic approach to conducting pain research, whereby patients are solely the subjects, has often been used for developing opioid and analgesic stewardship programs. As such, these programs have often inadequately identified important design inclusions and patient-centred outcomes. This novel research incorporates recommendations from ACTTION, to prioritise collaboration with patients and health providers. It hopes to enable meaningful engagement in shaping an analgesic education intervention for orthopaedic patients. It is predicted that this contemporary approach will effectively empower patients to optimise their pain management and increase the impact of this education on a range of outcomes that are deemed important by patients and healthcare providers alike.


References: 1. Shrestha S, Khatiwada AP, Sapkota B, et al. What is "Opioid Stewardship"? An Overview of Current Definitions and Proposal for a Universally Acceptable Definition. J Pain Res 2023;16:383-94.

2. Australian Commission on Safety and Quality in Heath Care . Opioid analgesic stewardship in acute pain. Clinical care standard – acute care edition, https://www.safetyandquality.gov.au/sites/default/files/2022-04/opioid-analgesic-stewardship-in-acute-pain-clinical-care-standard.pdf [accessed 4 Mar 2024].

3. Thomas C, Ayres M, Pye K, et al. Process, structural, and outcome quality indicators to support perioperative opioid stewardship: a rapid review. Perioper Med (Lond) 2023;12(1):34.

4. Walton LL, Duff E, Arora RC, McMillan DE. Surgery patients’ perspectives of their role in postoperative pain: A scoping review. International Journal of Nursing Studies Advances 2023;5:100124.

5. Haroutounian S, Holzer KJ, Kerns RD, et al. Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations. Pain 2024;165(5):1013-28.

6. Chen LM, Mirkazemi C, Veal FC. Are we educating patients about postoperative analgesics following orthopaedic surgery? A scoping review. Patient Educ Couns 2024;120:108123.