Table 2, Summary of studies included in the evidence review - Evidence review: Patient information and support

Table 2Summary of studies included in the evidence review

Study	Design	Population	Research aim	Comments
Opioids
Cooper 2013⁹⁴	Telephone interviews and thematic analysis	People self-reporting OTC medicine abuse (primarily codeine-containing products) n=25 (9 out of 25 were using medicine at time of the study) Age range 20s-60s UK	To describe the experiences and views of those self-reporting OTC medicine abuse, and why medicines were taken, how they were obtained, and associated treatment and support sought.	Drugs/products: Nurofen Plus (n=8), Solpadeine (n=5), Co-codamol (n=5), other codeine prescriptions (n=3), as well as other products, some in combination, including Paramol, Sudafed, Feminax, Phensedyl, Syndol, Nytol and Panadol ultra.
De Sola 2020¹⁰⁶	Semi-structured interviews and thematic analysis	Adults suffering from chronic non-malignant low back pain and receiving long-term treatment (>3 months) with opioids n=15 Age range 40-88 years Spain	To explore the experiences of people with chronic non-malignant low back pain undergoing long-term treatment with opioids.	Opioids prescribed: tapentadol, tramadol, oxycodone, morphine.
Frank 2016¹³⁴	Semi-structured interviews and thematic analysis	Adult primary care patients who were currently or had previously been, on chronic opioid therapy n=24 Mean age 52 years (range 31-73 years) Colorado, USA	To explore patients’ perspectives on opioid tapering.	Six participants (25%) were on chronic opioid therapy and not tapering, 12 (50%) were currently tapering opioids, and 6 (25%) had discontinued from chronic opioid therapy; mean duration of opioid therapy was 7.7 years (SD 5.9)
Goesling 2019¹⁴²	Focus groups and thematic analysis	Adults (18-70 years) with a history of taking opioids every day for 3 months or longer and no current opioid use n=24 Age range 18-70 USA	To identify themes of former opioid users’ experiences before, during and after opioid cessation.	Mixed methods study with quantitative and qualitative data. Also, included in withdrawal symptoms evidence review.
Gruss 2019¹⁵¹	Semi-structured interviews and thematic analysis	People with chronic pain on long-term opioid treatment who were randomised to the ‘usual care’ arm of the Pain Program for Active Coping and Training (PPACT) study n=97 Mean age (SD): 61.3 (12.1) years USA	To explore patients’ experiences using long-term opioid treatment of chronic pain in an integrated delivery system.	Participants were receiving care from the Kaiser Permanente (KP) integrated healthcare delivery system, in which primary, specialty and hospital care and pharmacy and laboratory services are provided to health plan members. They had a pain interference score of 4 or higher for the general activity item of the PEG scale (Pain, enjoyment, General activity) assessing pain intensity, pain’s interference with enjoyment of life and general activity, suggesting that opioid treatment was not fully successful in managing their pain. They were at various stages in their use of long-term opioids at the time of the interview (i.e., still prescribed, dosage decreased, completely tapered).
Henry 2019¹⁶³	Focus groups and interviews (n=7) and grounded theory analysis.	Adults with chronic back or neck pain in different stages of opioid tapering n=21 Mean age: 58 years. USA	To gain insight into patient experiences with opioid tapering by conducting focus groups and individual interviews with patients suffering from chronic neck and/or back pain.	N=14 had recently completed an opioid taper (with 4 no longer taking opioids); n=4 were in the process of tapering and n=3 had discussed tapering but had not made changes. Of the 7 patients who completed interviews, 4 had completed tapering, 2 were currently tapering and 1 had been recommended to taper.
Kinnaird 2019²⁰⁶	Semi-structured interviews with thematic analysis	Adults from the UK who had used codeine in the last 12 months other than as directed or as indicated n=16 Mean age 32.7 years (SD 10.1) UK	To investigate the views and experiences of people who use codeine in order to describe the ‘risk environment’ capable of producing and reducing harm.	Mean period of codeine use was 9.1 years (SD 7.6). All participants began using codeine to treat physical pain.
Matthias 2013²⁴⁴	In-depth interviews and thematic analysis.	Veteran Affairs primary care providers n=5 People with chronic pain n=30 Mean age (range): 57 (27 to 70 years), n=20 of which were taking a prescribed opioid medication for pain. USA	To understand how physicians and patients with chronic musculoskeletal pain communicated about issues related to opioids.
Paterson 2016³¹⁹	Semi-structured interviews and thematic analysis	People using long-term opioids for chronic non-cancer related pain n=20 Age range: 29-77 Australia	To explore the use of the “Model of medicine-taking” to identify the varying influences on patients’ decisions about their use of prescribed long-term opioids.	Sample was biased toward patients interested in nonmedication pain management options.
Slat 2021³⁹⁸	Semi-structured interviews and thematic analysis	Patients, primary care clinicians and office staff n=25 (15 patients, 7 clinicians, 3 office staff) Patient median age (range): 49 (35-69) years Patients were Michigan residents, had self-reported chronic pain and had had trouble in receiving opioid medication. USA	To understand barriers to primary care access and multimodal treatment for chronic pain from the perspective of multiple stakeholders.	Inclusion criteria changed during recruitment to include only men to balance the makeup of the sample. Patient ratio was 4/11 male/female
Webster 2019⁴⁶⁸	Open-ended interviews supplemented by observations	Primary care physicians and nurses working in urban, rural and Northern settings n=27 (19 physicians, 8 nurses) Age details not available Canada	To explore the social organization of chronic pain management from the standpoint of primary care physicians; research question: ‘How do primary care physicians describe the work they do in caring for patients with complex chronic conditions?’	Paper draws on data from an ongoing institutional ethnography of the coordination of care for chronic non-cancer pain in Canada; study reports on a subset of the original study data.
Wilson 2018⁴⁸⁷	Semi-structured interviews and grounded theory analysis	Adults enrolled in a single outpatient medication-assisted treatment (MAT) program for opioid use disorder n=10 Mean age (range): 47.6 (23-61) years USA	To examine the process involved when adults first initiate the use of opioid medicines to treat pain through enrolment in an outpatient MAT program.	Participants had been previously enrolled in a RCT piloting an online pain self-management program. Primary pain diagnoses were: neck and back pain (n=3), fibromyalgia (n=3) and arthritis (n=2)
Wyse 2019⁴⁹²	Secondary analysis of semi-structured interviews and qualitative content analysis.	Physicians and nurse practitioners caring for patients prescribed long-term opioid therapy n=24; 20 physicians, 4 nurses Mean age (SD): 49.5 (10) years USA	To understand how clinicians, adhere to recommendations for managing patients prescribed long-term opioid therapy.	The original larger study upon which the current secondary analysis was based focused on barriers to Urine drug testing among patients prescribed long-term opioid therapy for chronic pain.
Young 2017⁵⁰⁷	Semi-structured interviews and thematic analysis	UCLA Health System patients being treated for prescription opioid dependence and co-occurring chronic pain; Staff at UCLA clinics who worked with patients receiving chronic opioid therapy. n=15 (10 patients, 5 staff) Age details not provided. USA	To determine the acceptability and feasibility of using social media to reduce opioid-related complications among patients with chronic pain; in particular to evaluate the utility of the Harnessing Online Peer Education (HOPE) social media intervention to reduce the risk of addiction and overdose among non-cancer pain patients receiving chronic opioid therapy.	All patients met DSM-IV criteria for opioid dependence and were receiving treatment with buprenorphine.
Benzodiazepines
Choi 2021⁸⁴	Semi-structured interviews and thematic analysis	Adults aged 60 years and over who had been taking benzodiazepine for at least 3 months for insomnia or anxiety. Enrolled from the institutional research recruitment website. n=21 Mean age (SD): 66 (4.7) years USA	To explore older adults’ willingness to stop or lower the dose or frequency of their chronic benzodiazepine.	Themes included willingness to consider deprescribing their benzodiazepine in a hypothetical scenario
Parr 2006³¹⁶	Semi-structured interviews and qualitative analysis (not specified)	GPs n=28 Mean time in practice (range):14 years (6 months to 35 years) People taking benzodiazepines n=23, Mean age (range): 50 (25-79) years Australia	To gain more detailed understanding of perceptions relating to starting, continuing and stopping benzodiazepine use.	People taking benzodiazepines had at some time been prescribed daily benzodiazepines for 3 months or more. 30% were prescribed benzodiazepines for more than one mental health condition including panic disorder, depression, anxiety and post-traumatic stress disorder; six were currently prescribed benzodiazepines for panic attacks, ‘nerves’, sleeping problems, anxiety, obsessive compulsive behaviour or because they were addicted to them. For those who had ceased, mean length of time since cessation was 8 years (<1 year to 25 years).
Pérodeau 2016³²⁵	In-depth interviews (likely semi-structured) and grounded theory analysis.	Long-term mature benzodiazepine users n=23 Mean age (range): 64 (50-85) years, Primary care physicians n=9 Mean age (range): 50 (40-68) years, Pharmacists n=11, Mean age (range): 39 (26-52) years, Canada	1) To model chronic benzodiazepine use among community-dwelling mature adults, based on their subjective experiences of engaging in and maintaining benzodiazepine use; 2) To take into account their individual and contextual circumstance as well as broader social processes and macro-structures which trigger and/or maintain long-term benzodiazepine use. 3) To add parallel viewpoints of physicians and pharmacists among the French-speaking population in the Ottawa Valley (Ontario, Canada).	Five interviews with benzodiazepine users had been discarded because excluding factors had been missed during the screening process.
Voyer 2004⁴⁶¹	‘Directive’ interviews & inspection of medication containers; qualitative analysis method not reported.	Elderly, long-term users of benzodiazepines n=45, Mean age (SD): 79 (7.1) years Canada	To elicit descriptions of dependence from elderly long-term users of benzodiazepines that might reveal potential indicators of dependence other than long-term use (defined as six months or longer).	The study derives from a larger inquiry on the effects of a physical activity program on the well-being of elderly users of psychotropic drugs. Psychotropic polypharmacy was notable, with 28.8% of the sample prescribed two or more drugs. N=9 participants received concomitant prescriptions of antidepressants
Antidepressants
Anderson 2013²²	Supplementary (i.e., in-depth) secondary analysis of narrative interviews.	People with different types of depression and treatment experiences n=80 42 adults and 38 young people (age range 16-75). UK	To examine patient and health professional understanding of what it is like to use antidepressants from initiation of therapy and to determine factors which influence decisions about adherence to antidepressants in terms of perceived outcomes and determining factors that influenced their views.	Interviews were part of the Healthtalkonline database and were conducted in the University of Oxford as part of a primary study. The Healthtalkonline project uses narrative interviews to explore health and social care issues.
Anderson 2015²¹	Thematic analysis of interviews; combined analysis of three qualitative studies (all conducted by the authors)	Men and women who had taken antidepressants for depression n=108 Age groups in years: 20-29 n=25; 30-39 n=33; 40-49 n=27; 50-59 n=22; 60-69 n=9; 70-79 n=7; 80-89 n=1 UK and Australia	To explore people’s experiences of starting antidepressant treatment.	This paper combines data from three qualitative research studies, in which the main focus of each was slightly different: UKa & Australia studies focussed on ‘Experiences of depression’ and the UKb study focussed on ‘Experiences of using antidepressants.’
Eveleigh 2019¹²⁰	Semi-structured interviews and thematic analysis	Patients on long-term antidepressant use without a current indication (no psychiatric diagnosis) n=16 Mean age (range) 57 (women: 31-76; men: 51-79) years, using a variety of antidepressants Netherlands	To explore the attitudes of patients, who are using antidepressants long-term without a proper current indication, towards the discontinuation of these drugs, and to explore their attitudes towards the discontinuation advice they received when participating in an RCT.	Participants were recruited from the intervention group of a cluster-RCT as part of the intervention group they had been provided advice to stop antidepressants. n=7 participants intended to comply with the discontinuation advice during the RCT and n=5 of these actually discontinued during or after the RCT.
Guillaumie 2015¹⁵²	Focus groups (n=6) and (computer-assisted) thematic analysis	Community pharmacists from five regions of Quebec, majority of which (n-28) had over 15 years of experience in community pharmacy practice. n=43 Mean age: not reported Canada	To describe pharmacists’ perceptions with respect to their practices related to patients having an antidepressant drug treatment; identify challenges they encountered regarding their practices with those patients, and explore potential avenues for improvement of their practice regarding antidepressant drug treatment.	Pharmacists with different characteristics that potentially affect pharmacy practice (e.g., sex, age, employment status and worksite setting) were included.
Leydon 2007²²⁹	Face-to-face semi-structured qualitative interviews with thematic analysis	People taking selective serotonin reuptake inhibitors (SSRIs) n=17 Age range 28 to 64 years. UK	To explore patient experiences of, and beliefs about their long-standing SSRI use and understand the barriers and facilitators to discontinuation.	Seven participants described this as their first and only episode of depression. Of the rest, six talked in terms of previous distinct episodes, while four described their depression as ‘ongoing’ or ‘long-term’.
Nolan 2005²⁷⁸	Semi-structured interviews and qualitative analysis (not specified)	People prescribed antidepressant medication, who had experienced a first episode of depression in the past 18 months n=60 Mean age (range): 42 (24 to 67) years. UK	To explore what factors, lead patients to consider they have a satisfactory relationship with their prescribing clinician and what kind of information they find reassuring and helpful. To examine how medication regimens are monitored and what kind of follow-up patients appreciate, and to identify pointers for establishing effective therapeutic relationships between patients and prescribing clinicians.	Participants were recruited from four GP practices in the West Midlands, UK, two of which were located in urban settings and two in rural settings.
O’Mullan 2014²⁸⁷	Semi-structured interviews with thematic analysis	Women in a heterosexual relationship who had been taking SSRIs for longer than 3 months n=10 All under 45 years (no further information on age is provided) Australia	To explore women’s experiences of coping with the sexual side effects of antidepressant medication.	All participants had been taking SSRIs for longer than 3 months at time of study; all self-described as experiencing sexual difficulties that they believed to be attributed to SSRIs.
Pohjanoksa-Mantyla, 2009³²⁸	(Six) Focus groups and thematic analysis	Internet users with a present or past diagnosis of depression n=26 Mean age (range): 47 (20-69) years. Finland	To assess how and why people use the internet to access antidepressant information, and the self-reported impact of information obtained online.	Inclusion criteria: present or past use of an antidepressant, and use of the internet as a source of antidepressant information during the previous 12 months.
Verbeek-Heida 2006⁴⁵²	Interviews and grounded theory analysis	Adults taking SSRIs n=16; 9 women, 7 men Mean age 51 years (range 30-80 years) Netherlands	To provide insights into these processes of decision making from the patients’ point of view, in the hope that this might be useful for doctors when they talk with patients about continuing or stopping SSRIs.	All were using SSRIs at the time of interview; nine had previously attempted to stop taking SSRIs.
Vilhelmsson 2012⁴⁵⁶	Content analysis of free text comments from consumer reports	People reporting adverse drug reactions to antidepressant medications n=181 consumer reports Age range 16-75 years Sweden	To qualitatively analyse the free text comments appended to consumer reports on antidepressant medication.	The antidepressants most reported for a diagnosis of depression were Sertraline (23.8%), Citalopram (23.8%), Venlafaxine (23.2%), Mirtazapine (10.5%), Paroxetine (7.7%), Escitalopram (6.1%) and Fluoxetine (5.0%).

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Evidence review: Patient information and support: Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults: Evidence review A.

NICE Guideline, No. 215.

National Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2022 Apr.

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