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Systematic review
Decoding behaviour change techniques in opioid deprescribing strategies following major surgery: a systematic review of interventions to reduce postoperative opioid use
  1. Neetu Bansal1,
  2. Christopher J Armitage2,3,
  3. Rhiannon E Hawkes3,
  4. Sarah Tinsley4,
  5. Darren M Ashcroft5,6,
  6. Li-Chia Chen5
  1. 1Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health,Manchester Academic Health Science Centre, Oxford Road, University of Manchester, Manchester, UK
  2. 2NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
  3. 3Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
  4. 4Pharmacy Department, Royal Stoke University Hospitals, Stoke-on-Trent, UK
  5. 5Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  6. 6National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  1. Correspondence to Ms Neetu Bansal; neetu.bansal{at}manchester.ac.uk

Abstract

Methods A structured search strategy encompassing databases including MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting opioid reduction in adults following major surgeries. The risk of bias was evaluated using Cochrane risk-of-bias tool V.2 (RoB 2) and non-randomised studies of interventions (ROBINS-I) tools, and Cohen’s d effect sizes were calculated. BCTs were identified using a validated taxonomy.

Results 22 studies, comprising 7 clinical trials and 15 cohort studies, were included, with varying risks of bias. Educational (n=12), guideline-focused (n=3), multifaceted (n=5) and pharmacist-led (n=2) interventions demonstrated diverse effect sizes (small-medium n=10, large n=12). A total of 23 unique BCTs were identified across studies, occurring 140 times. No significant association was observed between the number of BCTs and effect size, and interventions with large effect sizes predominantly targeted healthcare professionals. Key BCTs in interventions with the largest effect sizes included behaviour instructions, behaviour substitution, goal setting (outcome), social support (practical), social support (unspecified), pharmacological support, prompts/cues, feedback on behaviour, environmental modification, graded tasks, outcome goal review, health consequences information, action planning, social comparison, credible source, outcome feedback and social reward.

Conclusions Understanding the dominant BCTs in highly effective interventions provides valuable insights for future opioid tapering strategy implementations. Further research and validation are necessary to establish associations between BCTs and effectiveness, considering additional influencing factors.

PROSPERO registration number CRD42022290060.

  • Surgery
  • Patient safety
  • Healthcare quality improvement

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjqs-2024-017265

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @pharmneetu, @rhiannonhawkes, @LiChiaChen

    • Correction notice This article has been corrected since it was first published online. The author Li-Chia Chen has been moved to the end of the authorship list.

    • Contributors NB is the guarantor for this project. NB led the project supervised by CJA, L-CC and DMA and conceptualised the research ideas. NB, CJA, DMA and L-CC were involved in the planning and preparation of the study. NB and ST identified articles for inclusion and undertook the data extraction. NB and REH coded the behaviour change techniques, which CJA resolved in case of discrepancies. NB managed and led data collection and analysis. NB drafted the initial version of the manuscript. The lead supervisor, L-CC, oversaw the project development and managed the progress. All authors approved the final version of the paper. Two patient representatives (AC and LJ) provided feedback on the study results.

    • Funding This study was funded by NIHR (NIHR301585).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.