{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:00:05Z","timestamp":1787882405714,"version":"build-2784847793"},"reference-count":23,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T00:00:00Z","timestamp":1574640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000897","name":"Cystic Fibrosis Foundation","doi-asserted-by":"publisher","award":["K01HL133466"],"award-info":[{"award-number":["K01HL133466"]}],"id":[{"id":"10.13039\/100000897","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pain and opioid management are core ambulatory palliative care skills. Existing literature on how to manage opioid misuse\/use disorder excludes patients found in palliative care settings, such as individuals with serious illness or those at the end of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We conducted an exploratory study to: (1) Identify the challenges palliative care clinicians face when prescribing opioids in ambulatory settings and (2) explore factors that affect opioid decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We recruited palliative care clinicians who prescribe opioids in ambulatory settings, which included open-ended questions and was conducted online. Results were analyzed qualitatively using a content analysis-based approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eighty-three palliative care clinicians (mostly MDs\/DOs) participated. Challenges faced when prescribing opioids included clinician differences in approach to care (eg, transitioning from another clinician with more permissive opioid prescribing), medication access (eg, inadequate pharmacy supply), resource constraints (eg, access to mental health and addiction expertise), managing problems outside the typical palliative care scope (eg addiction). Participants also discussed factors that influenced their opioid prescribing decisions, such as opioid-related harms and risks that they need to weigh; they also spoke about the necessity of considering other factors like the patient\u2019s environment, disease, treatment, and prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study highlights the challenge of opioid management in patients with serious illness, particularly when misuse or substance use disorder is present, and suggests areas for future research focus. Our next step will be to establish consensus on approaches to opioid prescribing decision-making and policy in seriously ill patients presenting to ambulatory palliative care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1049909119890556","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T11:00:15Z","timestamp":1574679615000},"page":"507-513","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":36,"title":["Managing Opioids, Including Misuse and Addiction, in Patients With Serious Illness in Ambulatory Palliative Care: A Qualitative Study"],"prefix":"10.1177","volume":"37","author":[{"given":"Jessica S.","family":"Merlin","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA, USA"},{"name":"Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah R.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Social Work, College of Community and Public Affairs, Binghamton University, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Arnold","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey W.","family":"Bulls","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Childers","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Gauthier","sequence":"additional","affiliation":[{"name":"Department of Family and Emergency Medicine, Universit\u00e9 Laval Cancer Research Center, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karleen F.","family":"Giannitrapani","sequence":"additional","affiliation":[{"name":"VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA"},{"name":"Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dio","family":"Kavalieratos","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Schenker","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Deanna","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane M.","family":"Liebschutz","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,11,25]]},"reference":[{"key":"bibr1-1049909119890556","doi-asserted-by":"publisher","DOI":"10.7326\/AITC201803060"},{"key":"bibr2-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"bibr3-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.10.493"},{"key":"bibr4-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1097\/01.j.pain.0000460357.01998.f1"},{"key":"bibr5-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.117"},{"key":"bibr6-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000505"},{"key":"bibr7-1049909119890556","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-152-2-201001190-00006"},{"issue":"1","key":"bibr8-1049909119890556","first-page":"85","volume":"17","author":"Dasgupta N","year":"2016","journal-title":"Pain Med"},{"key":"bibr9-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.03.040"},{"key":"bibr10-1049909119890556","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1136"},{"key":"bibr11-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002396"},{"key":"bibr12-1049909119890556","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1"},{"key":"bibr13-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.68.5206"},{"issue":"10","key":"bibr14-1049909119890556","first-page":"1","volume":"12","author":"Hsu C-CS","year":"2007","journal-title":"Pract Assess Res Eval"},{"key":"bibr15-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1016\/j.im.2003.11.002"},{"key":"bibr16-1049909119890556","volume-title":"Qualitative Inquiry: Choosing Among Five Approaches","author":"Creswell JW","year":"2017","edition":"4"},{"key":"bibr17-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1177\/1049732316665344"},{"key":"bibr18-1049909119890556","volume-title":"The Coding Manual for Qualitative Researchers","author":"Saldana J","year":"2016","edition":"3"},{"key":"bibr19-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"bibr20-1049909119890556","doi-asserted-by":"publisher","DOI":"10.3102\/0013189X034002003"},{"issue":"1","key":"bibr21-1049909119890556","first-page":"26","volume":"21","author":"Olson JD","year":"2016","journal-title":"Qual Rep"},{"key":"bibr22-1049909119890556","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.9739"},{"key":"bibr23-1049909119890556","unstructured":"Merlin JS, Dreyfus A, Tulsky J. 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