{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:35:30Z","timestamp":1792787730714,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Cancer Institute","award":["R01 CA267996-01A1"],"award-info":[{"award-number":["R01 CA267996-01A1"]}]},{"name":"National Cancer Institute","award":["P30CA008748"],"award-info":[{"award-number":["P30CA008748"]}]},{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"crossref","award":["RSGI-22-130-01-HOPS"],"award-info":[{"award-number":["RSGI-22-130-01-HOPS"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100014367","name":"National Palliative Care Research Center","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014367","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100015348","name":"Cambia Health Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015348","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with cancer-related pain are at high risk for aberrant drug use behaviors (ADB), including self-escalation, diversion and concurrent illicit substance or opioid misuse; however, limited evidence is available to guide opioid prescribing for patients with life-limiting illness and concurrent or suspected ADB. We sought to characterize how specialists evaluate for and manage these high-risk behaviors in patients with cancer-related pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted telephonic semi-structured interviews with palliative care and pain medicine providers. Participants discussed their own comfort and experience level with identifying and managing ADB in patients with life-limiting illness. They were subsequently presented with a series of standardized scenarios and asked to describe their concerns and management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>95 interdisciplinary pain and palliative care specialists were contacted; 37 agreed to participate (38.9%). Analysis of interview contents revealed several central themes: (1) widespread discomfort and anxiety regarding safe and compassionate opioid prescribing for high-risk patients, (2) belief that widely used risk-mitigation tools such as opioid contracts and urine drug screens provided inadequate support for decision-making, and (3) lack of institutional and organizational support and guidance for safe prescribing strategies. Most clinicians reported self-education regarding addiction and alternative prescribing\/pain management strategies. Providers varied widely in their willingness to discontinue opioid prescribing in a patient with aberrant behavior and pain associated with life-limiting illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Providers caring for patients demonstrating ADB and cancer-related pain struggle to balance safe prescribing with symptom management. Increased guidance is needed regarding opioid prescribing, monitoring, and discontinuation in high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091241259034","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T18:23:35Z","timestamp":1717439015000},"page":"489-503","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Dangerous Variation or Patient-Centered Care? Palliative Care and Pain Providers\u2019 Comfort, Experiences, and Approaches when Treating Cancer Pain With Coexisting Aberrant Behaviors"],"prefix":"10.1177","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8954-0297","authenticated-orcid":false,"given":"Rachel A.","family":"Hadler","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Emory University, Atlanta, GA, USA"},{"name":"Emory Critical Care Center, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Klinedinst","sequence":"additional","affiliation":[{"name":"Palliative Care Alliance, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Jones","sequence":"additional","affiliation":[{"name":"Palliative Care Program, Department of Medicine, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhua","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill-Cornell Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Pathak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Emory University, Atlanta, GA, USA"},{"name":"Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali J.","family":"Zarrabi","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0680-8911","authenticated-orcid":false,"given":"William E.","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1200\/op.20.01041"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol30060437"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/jco.22.02198"},{"key":"e_1_3_5_5_2","volume-title":"WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents","author":"Committee WG","year":"2019","unstructured":"Committee WG. 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