Stakeholder perspectives on the reduction of opioid exposure in ICU: A modified Delphi survey
Bibliographic record
Abstract
PURPOSE: The global opioid epidemic highlights the need to re-evaluate pain management strategies and find alternatives to minimize opioid exposure. Opioids are primary analgesics and sedatives in intensive care units (ICUs) but may have negative consequences for patients and families. This study aimed to identify key patient-important outcomes related to opioid reduction and the use of analgesic adjuncts (e.g., non-steroidal anti-inflammatory drugs [NSAIDs]) in critically ill adult patients through a modified Delphi study involving patients, families, and healthcare providers. METHODS: A modified Delphi process, including two survey rounds and one discussion round among stakeholders (patients, family members, and healthcare providers), was used to identify and rate key patient-important outcomes, evaluation time-points, and suitable tools/definitions for a potential randomized controlled trial. RESULTS: Opioid reduction was identified as a key patient-important outcome by 82% of participants across both survey rounds. Various themes emerged from surveys and stakeholder meetings, showing a preference for both pharmacological and non-pharmacological adjunctive therapies for ICU pain management. Opinions varied based on clinical or non-clinical backgrounds. CONCLUSIONS: Participants agreed that reducing opioid exposure and using adjunctive pain management strategies are crucial patient-important outcomes. Further research is needed to explore the efficacy and safety of opioid alternatives and both pharmacologic and non-pharmacologic interventions. IMPLICATIONS FOR CLINICAL PRACTICE: This study highlights that both patients and families value reducing opioid exposure and exploring alternatives, aligning with healthcare providers' goals. Improved communication and education about opioid use can enhance patient-centered care. These findings support the need for future trials on adjunctive analgesics to reduce opioid exposure and improve outcomes, addressing both clinical and patient-family perspectives.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".