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Objective: Opioid stewardship interventions promote appropriate use of opioids. We synthesized evidence from recent studies on the effectiveness of opioid stewardship interventions in United States healthcare settings on opioid prescribing and clinical outcomes. Methods: We followed the Evidence-based Practice Center Program's rapid review processes. We searched PubMed and Cochrane for original studies meeting specified inclusion criteria from January 2016 (correlating with the Centers for Disease Control and Prevention Pain Guidelines) to April 2023, supplemented by gray literature searches. Findings: Our search identified 13 randomized controlled trials and 6 nonrandomized studies. Randomized controlled trials addressed interventions involving multiple components (typically combining prescriber education, care management, and facilitated access to resources), clinical decision support (CDS) or electronic health records (EHR), and patient education and engagement, mainly in ambulatory chronic pain. Multicomponent interventions and opioid stewardship practices involving CDS or EHR were associated with decreased opioid prescribing or reduced doses and no increases in pain, emergency department visits, or hospitalizations (low strength of evidence for all outcomes). Patient engagement and education interventions had mixed results for opioid prescribing outcomes (insufficient strength of evidence) and no increases in pain, emergency department visits, or hospitalizations (low strength of evidence). Conclusions: Selected opioid stewardship interventions may be effective for reducing opioid prescribing without adversely affecting clinical outcomes. Interventions to reduce opioid prescribing should monitor unintended consequences and include access to nonpharmacological pain management resources with patient education and engagement. [ABSTRACT FROM AUTHOR]

Purpose Patients with head and neck cancer are at risk for disease- and treatment-related toxicities that may be severe enough to require hospitalization. The risk factors associated with hospitalization in these patients are not well defined. Methods We conducted a single-center, retrospective observational study of patients with head and neck cancer receiving chemotherapy at an academic medical center infusion clinic in a one-year period. The primary objective was to characterize the head and neck cancer population at an academic medical center. Secondary objectives included describing the clinical and social factors associated with hospitalization. Results There were 109 patients with head and neck cancer included in the analysis. Of these patients, 38 (35%) were hospitalized. The factors that were significantly associated with hospitalization on univariable logistic regression were former alcohol abuse, being on a nonstandard of care chemotherapy regimen, and having a chemotherapy agent discontinued. On multivariable logistic regression, the factor that was significantly associated with hospitalization was having a chemotherapy agent discontinued. The most common reasons for hospitalization included shortness of breath/respiratory failure, fever/neutropenic fever, and infection. The most common new supportive care medications prescribed at discharge were stool softeners or laxatives and opioids. Conclusion This study identified several factors which may be useful to identify patients as high risk for hospitalization and the next steps will be to determine and study the role of the pharmacist in preventing hospitalization of these patients. Further studies are needed to assess the impact of adding a pharmacist to the head and neck cancer multidisciplinary team. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to describe the use of goals of care meetings in patients with advanced or refractory cancer at risk for critical care interventions. Topics discussed include study design and analysis of study, goals of care meetings in providing usual care team and palliative care, and improving concordance between patients' preferences and health care utilization.