A Pharmacist-partnered Opioid-tapering Service before Total Hip or Knee Arthroplasty: Qualitative Analysis of Patient Counseling Sessions

Background: Currently, no literature on patients' experiences with opioid tapering before elective surgery has been published. Recent evidence indicates that tapering opioids before total hip or knee arthroplasty improves postsurgical outcomes. This study qualitatively analyzed consultation sessions of patients receiving a pharmacist-partnered opioid-tapering service before total hip or knee replacement surgery to understand their experiences and attitudes. Methods: A qualitative analysis of pharmacist counseling sessions within a randomized controlled trial was conducted. Participants were those recruited from seven hospitals between December 2021 and September 2022 who were assigned to the pharmacist-partnered opioid-tapering intervention arm of a randomized controlled trial. Consultations of participants with the pharmacist were audio-recorded and transcribed verbatim. Consultation data underwent inductive thematic analysis. Results: Consultations were available for 20 participants, with a total of 48 audio-recorded consultations. Among these participants, four major themes including motivations to taper, knowledge and beliefs, psychosocial context, and attitudes toward tapering opioids were identified. Of the 20 participants, 70% tapered their opioids 50% or greater, with awareness of the surgery date appearing to be a key external motivating factor to taper opioids, regardless of the dose of opioids. Another notable theme was the motivation to improve fitness for participation in social activities, allowing participants to interact more with their kids and grandkids. Additionally, participant's psychosocial context revealed that factors such as stress affected their ability to taper. Pharmacists played a foundational role in shaping patients' attitudes and optimization of pain management strategies. Attitudes were identified as "optimistic,""hesitant,"and "resistant,"with patients displaying an optimistic attitude being more likely to taper. Conclusions: Exploring the experiences of patients with osteoarthritis in a pharmacist-led opioid-tapering service before elective surgery revealed that external motivations, such as knowledge of a surgery date, play a crucial role in successful opioid tapering. Patients were more likely to taper if they knew their surgery date. Attitudes toward opioid tapering were identified as a modifiable factor. Tailoring tapering plans and patient education to individual patient contexts may enhance tapering outcomes.