{"doi":"10.1093/pm/pnz361","title":"Medical Record Documentation About Opioid Tapering: Examining Benefit-to-Harm Framework and Patient Engagement","abstract":"OBJECTIVE: Guidelines recommend that clinicians make decisions about opioid tapering for patients with chronic pain using a benefit-to-harm framework and engaging patients. Studies have not examined clinician documentation about opioid tapering using this framework. DESIGN AND SETTING: Thematic and content analysis of clinician documentation about opioid tapering in patients' medical records in a large academic health system. METHODS: Medical records were reviewed for patients aged 18 or older, without cancer, who were prescribed stable doses of long-term opioid therapy between 10/2015 and 10/2016 then experienced an opioid taper (dose reduction ≥30%) between 10/2016 and 10/2017. Inductive thematic analysis of clinician documentation within six months of taper initiation was conducted to understand rationale for taper, and deductive content analysis was conducted to determine the frequencies of a priori elements of a benefit-to-harm framework. RESULTS: Thematic analysis of 39 patients' records revealed 1) documented rationale for tapering prominently cited potential harms of continuing opioids, rather than observed harms or lack of benefits; 2) patient engagement was variable and disagreement with tapering was prominent. Content analysis found no patients' records with explicit mention of benefit-to-harm assessments. Benefits of continuing opioids were mentioned in 56% of patients' records, observed harms were mentioned in 28%, and potential harms were mentioned in 90%. CONCLUSIONS: In this study, documentation of opioid tapering focused on potential harms of continuing opioids, indicated variable patient engagement, and lacked a complete benefit-to-harm framework. Future initiatives should develop standardized ways of incorporating a benefit-to-harm framework and patient engagement into clinician decisions and documentation about opioid tapering.","journal":"Pain Medicine","year":2020,"id":88841,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9027,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":449727,"name":"Hector R. Perez","orcid":"0000-0002-7070-6522","position":1,"is_corresponding":false},{"id":450578,"name":"Jordan Stumph","orcid":null,"position":2,"is_corresponding":false},{"id":449728,"name":"Robert W. Allen","orcid":"0000-0001-5491-683X","position":3,"is_corresponding":false},{"id":367628,"name":"Shadi Nahvi","orcid":"0000-0001-5501-4942","position":4,"is_corresponding":false},{"id":315647,"name":"Chinazo O. Cunningham","orcid":"0000-0002-7930-313X","position":5,"is_corresponding":false},{"id":430080,"name":"Jessica S. Merlin","orcid":"0000-0003-3207-4875","position":6,"is_corresponding":false},{"id":367626,"name":"Joanna L. Starrels","orcid":"0000-0002-1865-1966","position":7,"is_corresponding":false},{"id":449726,"name":"Michele Buonora","orcid":"0000-0003-1425-1938","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-18T22:01:22.387926Z","pmid":"32142143","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}