Utilization of Palliative Care for Patients with Acute Kidney Injury and COVID-19

Background.Patients with cancerrelated pain are at high risk for aberrant opioid and drug use behaviors (ADB); however, limited evidence is available to guide opioid prescribing for patients with life-limiting illness and ADB.Research Objectives.To characterize how specialist providers evaluate for and manage self-escalation, diversion, and other high-risk behaviors in patients with cancer-related pain.Methods.Telephonic semistructured 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.Results.We interviewed 30 providers.Analysis of interview contents revealed several central themes: discomfort and anxiety regarding opioid prescribing for high-risk patients, belief that widely used risk mitigation tools such as opioid contracts and urine drug screens provided inadequate support for decision making, a perceived lack of institutional and organizational support and guidance for safe prescribing strategies, and self-education and empowerment regarding addiction and alternative prescribing and pain management strategies.Providers varied widely in their willingness to discontinue opioid prescribing in a patient with ADB and pain associated with life-limiting illness.Conclusion.Providers caring for patients demonstrating ADB in the setting of cancer-related pain struggle to balance safe prescribing with symptom management.Implications for Research, Policy, or Practice.Increased guidance is needed regarding opioid prescribing, monitoring, and discontinuation for patients demonstrating high-risk behaviors.Future research should systematically evaluate strategies for identifying and compassionately managing high-risk drug-related behavior for patients with life-limiting illnesses.