Patient acceptability of a proposed clinical pharmacist-led review for persistent pain in primary care (PROMPPT study)
Randomised controlled trials of complex interventions often fail to show an intervention effect. This could be due to suboptimal intervention design if the intervention it is not acceptable to participants receiving it or those delivering it. This is a problem for researchers and funders as it leads to poor uptake of interventions and high attrition rates resulting in bias and reduced internal validity. “Acceptability” as a concept is often not defined. We draw on a new Theoretical Framework of Acceptability (TFA) of health care interventions to inform development of a clinical pharmacist-led primary care review for patients prescribed opioids for persistent pain.
Patients in the West Midlands living with persistent pain (> 6 months) and taking regular opioids were invited to participate in face-to-face semi-structured interviews (n=15) to investigate acceptability of a proposed PROMPPT review led by clinical pharmacists. An online qualitative study (n=69), using a dedicated discussion forum which was live for 11 weeks, was conducted to capture the views of people beyond the West Midlands, and those unable or unwilling to participate in person. The interview topic guide and online discussion questions were informed by TFA constructs of affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. Interviews were transcribed verbatim and online discussions downloaded and analysed in Nvivo12. Data were deductively coded onto constructs of the TFA. Members of the qualitative research team met regularly to discuss analysis decisions.
Data coded into all TFA constructs targeting two areas of intervention acceptability, namely (i) acceptability of seeing a clinical pharmacist for a pain review, and (ii) acceptability of reducing opioid medicines. For example, patients perceived being offered a regular review for persistent pain as valuable (ethicality), however anticipated feeling anxious about attending a review as they expected opioid medicines to be reduced or taken away (affective attitude). When attending the review, patients reported the need for clinical pharmacists to show empathy, compassion, and understanding (perceived effectiveness) and shared ways to support belief in ability to live better with pain (self-efficacy).
Overall findings indicate elements of the proposed PROMPPT review to be acceptable. Pertinent for the developmental phase, findings also point to areas for improvement in order to enhance levels of acceptability for patients ahead of a feasibility study. Findings have informed PROMPPT review’s iterative design and illustrate the importance of evaluating acceptability during the earliest stages of intervention development.