Show simple item record

dc.contributor.authorLapane, Kate L.
dc.contributor.authorDube, Catherine E.
dc.contributor.authorHume, Anne L.
dc.contributor.authorTjia, Jennifer
dc.contributor.authorJesdale, William M.
dc.contributor.authorPawasauskas, Jayne
dc.contributor.authorKhodyakov, Dmitry
dc.date2022-08-11T08:08:26.000
dc.date.accessioned2022-08-23T15:55:24Z
dc.date.available2022-08-23T15:55:24Z
dc.date.issued2021-04-01
dc.date.submitted2021-04-23
dc.identifier.citation<p>Lapane KL, Dubé C, Hume AL, Tjia J, Jesdale BM, Pawasauskas J, Khodyakov D. Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study. Drugs Aging. 2021 Apr;38(4):327-340. doi: 10.1007/s40266-021-00836-8. Epub 2021 Feb 24. PMID: 33624228. <a href="https://doi.org/10.1007/s40266-021-00836-8">Link to article on publisher's site</a></p>
dc.identifier.issn1170-229X (Linking)
dc.identifier.doi10.1007/s40266-021-00836-8
dc.identifier.pmid33624228
dc.identifier.urihttp://hdl.handle.net/20.500.14038/29745
dc.description.abstractBACKGROUND: Evidence to guide clinical decision making for pain management in nursing home residents is scant. OBJECTIVE: Our objective was to explore the extent of consensus among expert stakeholders regarding what analgesic issues should be prioritized for comparative-effectiveness studies of beneficial and adverse effects of analgesic regimens in nursing home residents. METHODS: Two stakeholder panels (nurses only and a mix of clinicians/researchers) were engaged (n = 83). During a three-round online modified Delphi process, participants rated and commented on the need for new evidence on nonopioid analgesic regimens and opioid regimens, short-term adverse effects, long-term adverse effects, comorbid conditions, and other factors in the nursing home setting (9-point scale; 1 = not essential to 9 = very essential to obtain new evidence). The quantitative data were analyzed to determine the existence of consensus using an approach from the RAND/UCLA Appropriateness Method User's Manual. The qualitative data, consisting of participant explanations of their numeric ratings, were thematically analyzed by an experienced qualitative researcher. RESULTS: For nursing home residents, evidence generation was deemed essential for opioids, gabapentin (alone or with serotonin norepinephrine reuptake inhibitors [SNRIs]), and nonsteroid anti-inflammatory drugs with SNRIs. Experts prioritized the following outcomes as essential: long-term adverse effects, including delirium, cognitive decline, and decline in activities of daily living (ADLs). Kidney disease and depression were deemed essential conditions to consider in studies of pain medications. Coprescribing analgesic regimens with benzodiazepines, sedating medications, serotonergic medications, and non-SNRI antidepressants were considered essential areas of study. Experts noted that additional study was essential in residents with moderate/severe cognitive impairment and limitations in ADLs. CONCLUSIONS: Stakeholder priorities for more evidence reflect concerns related to treating medically complex residents with complex drug regimens and included long-term adverse effects, coprescribing, and sedating medications. Carefully conducted observational studies are needed to address the vast evidence gap for nursing home residents.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=33624228&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1007/s40266-021-00836-8
dc.subjectGeriatrics
dc.subjectPain Management
dc.subjectPharmaceutical Preparations
dc.subjectTherapeutics
dc.titlePriority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study
dc.typeJournal Article
dc.source.journaltitleDrugs and aging
dc.source.volume38
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/1958
dc.identifier.contextkey22628116
html.description.abstract<p>BACKGROUND: Evidence to guide clinical decision making for pain management in nursing home residents is scant.</p> <p>OBJECTIVE: Our objective was to explore the extent of consensus among expert stakeholders regarding what analgesic issues should be prioritized for comparative-effectiveness studies of beneficial and adverse effects of analgesic regimens in nursing home residents.</p> <p>METHODS: Two stakeholder panels (nurses only and a mix of clinicians/researchers) were engaged (n = 83). During a three-round online modified Delphi process, participants rated and commented on the need for new evidence on nonopioid analgesic regimens and opioid regimens, short-term adverse effects, long-term adverse effects, comorbid conditions, and other factors in the nursing home setting (9-point scale; 1 = not essential to 9 = very essential to obtain new evidence). The quantitative data were analyzed to determine the existence of consensus using an approach from the RAND/UCLA Appropriateness Method User's Manual. The qualitative data, consisting of participant explanations of their numeric ratings, were thematically analyzed by an experienced qualitative researcher.</p> <p>RESULTS: For nursing home residents, evidence generation was deemed essential for opioids, gabapentin (alone or with serotonin norepinephrine reuptake inhibitors [SNRIs]), and nonsteroid anti-inflammatory drugs with SNRIs. Experts prioritized the following outcomes as essential: long-term adverse effects, including delirium, cognitive decline, and decline in activities of daily living (ADLs). Kidney disease and depression were deemed essential conditions to consider in studies of pain medications. Coprescribing analgesic regimens with benzodiazepines, sedating medications, serotonergic medications, and non-SNRI antidepressants were considered essential areas of study. Experts noted that additional study was essential in residents with moderate/severe cognitive impairment and limitations in ADLs.</p> <p>CONCLUSIONS: Stakeholder priorities for more evidence reflect concerns related to treating medically complex residents with complex drug regimens and included long-term adverse effects, coprescribing, and sedating medications. Carefully conducted observational studies are needed to address the vast evidence gap for nursing home residents.</p>
dc.identifier.submissionpathfaculty_pubs/1958
dc.contributor.departmentDivision of Epidemiology, Department of Population and Quantitative Health Sciences
dc.source.pages327-340


This item appears in the following Collection(s)

Show simple item record