Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice J Pediatr Surg . Author manuscript; available in PMC: 2026 Apr 14. Published in final edited form as: J Pediatr Surg. 2023 Dec 19;59(4):718–724. doi: 10.1016/j.jpedsurg.2023.12.015 Search in PMC Search in PubMed View in NLM Catalog Add to search Adolescent and Parent Perceptions of Postoperative Opioid Use: A Qualitative, Thematic Analysis Marjorie N Odegard Marjorie N Odegard , MD a. Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA, 90027 Find articles by Marjorie N Odegard a , Rachel Carmen Ceasar Rachel Carmen Ceasar , PhD b. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA 90032 Find articles by Rachel Carmen Ceasar b , Donia Hijaz Donia Hijaz , BA a. Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA, 90027 Find articles by Donia Hijaz a , Adaeze Obinelo Adaeze Obinelo , BA c. Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 Find articles by Adaeze Obinelo c , Alvina Rosales Alvina Rosales , PhD c. Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 d. Division of Pain Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 f. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 Find articles by Alvina Rosales c, d, f , Sumeet Bhanvadia Sumeet Bhanvadia , MD e. Aresty Department of Urology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 Find articles by Sumeet Bhanvadia e , Matthew Kirkpatrick Matthew Kirkpatrick , PhD b. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA 90032 g. Department of Psychology, Dornsife College of Letters, Art and Sciences, University of Southern California, 3620 South McClintock Ave, Los Angeles, CA, 90089 Find articles by Matthew Kirkpatrick b, g , Eugene Kim Eugene Kim , MD d. Division of Pain Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 f. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 Find articles by Eugene Kim d, f , Lorraine I Kelley-Quon Lorraine I Kelley-Quon , MD a. Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA, 90027 b. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA 90032 Find articles by Lorraine I Kelley-Quon a, b Author information Article notes Copyright and License information a. Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, 4650 Sunset Boulevard, Los Angeles, CA, 90027 b. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA 90032 c. Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 d. Division of Pain Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 e. Aresty Department of Urology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 f. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 g. Department of Psychology, Dornsife College of Letters, Art and Sciences, University of Southern California, 3620 South McClintock Ave, Los Angeles, CA, 90089 ✉ Correspondence Address: Marjorie N. Odegard, MD, Post-Doctoral Research Fellow, Division of Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #100, Los Angeles, CA 90027, [email protected] Issue date 2024 Apr. PMC Copyright notice PMCID: PMC13075514 NIHMSID: NIHMS1954898 PMID: 38184435 The publisher's version of this article is available at J Pediatr Surg Abstract Background: Little is known about how families make decisions regarding postoperative prescription opioid consumption. This qualitative study examines adolescent and parent perspectives on postoperative prescription opioid use. Methods: We recruited adolescents aged 13–20 years old who received a postoperative opioid prescription and their parents from a previous longitudinal cohort study. We employed purposive sampling for recruitment to reflect local community sociodemographics including race/ethnicity, health literacy, and Spanish-language preference then conducted thematic analysis of focus group feedback. Results: Participants met in four virtual focus groups: adolescents from English-speaking households(n=2), adolescents from Spanish-speaking households(n=5), English-speaking parents(n=4), and Spanish-speaking parents (n=4). Five themes emerged: Parents (1) feared opioid use would result in overdose or addiction and (2) desired information about alternative medical and behavioral strategies to minimize use. (3) Parents felt empowered to manage their adolescent’s opioid use and trusted their adolescent to prompt them for opioids. Adolescents trusted their parents to manage their opioid use but maintained their autonomy to limit opioid consumption when experiencing undesirable side effects. (4) Some adolescents and parents endorsed a preference for “not taking medication” in their households. (5) Both parents and adolescents reported previous knowledge of opioids prior to surgery, with adolescents learning more nuanced information about opioid safety after their surgeries. Conclusions: Families feel empowered to manage their postoperative prescription opioid use but fear the negative effects of opioids and desire information on alternatives. Evidence-based, family-centric education from providers in a language preferred by the family could mitigate families’ concerns and contribute to improved pain control and safety. Keywords: opioid, surgery, pediatric, qualitative Introduction Adolescents who undergo surgery frequently receive more pills than needed.[ 1 – 3 ] With opioid related overdose death increasing in youth,[ 4 ] surgeons and healthcare providers must balance providing adequate postoperative analgesia with minimizing the risk of excess prescription opioids within the home. However, efforts to mitigate excess opioid prescribing must dovetail with appropriate education on safe prescription opioid use, storage and disposal. Currently, little is known about factors that drive prescription opioid use behaviors and decision making after adolescents leave the hospital. Such feedback could inform prescribers on how best to educate patients and caregivers about managing opioid consumption after surgery and minimizing excess opioid prescriptions. Previous studies demonstrate that appropriate educational tools can help caregivers of children who have undergone surgery improve patient pain control[ 5 ] and recognize adverse medication effects.[ 6 ] The purpose of this study was to solicit feedback from adolescents who underwent surgery and their parents regarding their experience with and perspectives on prescription opioid use, misuse, and safety. Methods Participation and Recruitment We recruited participants from a previous survey-based longitudinal cohort study focusing on postoperative opioid use in adolescents performed at our hospital[ 7 ]. The study was performed at our hospital which has approximately 65% Latinx and a high percentage of Spanish-speaking parents. The original study recruited adolescents ages 13–20 years old who were scheduled to undergo a surgery commonly associated with a postoperative opioid prescription, along with their parents. The surgeries that the adolescents underwent included posterior spinal fusion, pectus excavatum repair, hip reconstruction, arthroscopy, pilonidal excision, and tonsillectomy. Participants were recruited during the adolescent’s preoperative clinic appointments from February 2019 to February 2020, and enrolled after obtaining written informed consent. Parents and caregivers for each adolescent were also recruited and enrolled after obtaining written informed consent. In October 2021, participants from the survey-based longitudinal cohort study were recruited to take part in virtual focus group sessions to discuss their experience using prescription opioids after surgery and to give feedback on a brochure about managing children’s pain after surgery ( Appendix 1 ). Participants were first sent informational emails about the study, which also contained a copy of the age-appropriate consent, which informed them that they would be contacted for formal study enrollment via a phone call. During follow-up phone calls, participants were enrolled in the focus groups and verbal consent was obtained. For participants who were under 18 years of age, their parents provided verbal consent via telephone. Recruitment was balanced for preferred language spoken (English or Spanish) and health literacy level based on previous survey answers. Our desired number of participants in each of the 4 focus groups was 6 for a total of 24 participants. We initially reached out to a total of 47 eligible participants in order to increase our participant yield and to assure balanced cohorts with regards to health literacy and language spoken. Of the 47 participants initially contacted for participation via informational email and subsequent recruitment phone call, 13 participants did not response and 7 declined participation. Twelve participants who had enrolled in the study did not show up for the scheduled focus groups, leaving a total of 15 participants. Due to efforts to balance participant demographics, participants were not always recruited in their parent-adolescent dyads in which they enrolled in the original study. This study was approved by the Institutional Review Board at Children’s Hospital Los Angeles. Interviews Focus groups were conducted over a HIPAA-compliant Zoom interface (Zoom Video Communications, San Jose, CA). The focus group that consisted of primarily Spanish-speaking parents was conducted in Spanish, while the other 3 focus groups were conducted in English. The adolescents who spoke Spanish at home preferred to speak English during the focus group. Topics covered during the sessions included past experiences with and knowledge about opioids, fears about side effects, and opinions about when to take or not take medication. Participants were compensated with $50 gift cards once the focus groups were completed. Data analysis A HIPAA compliant external transcribing service transcribed the focus group interviews that were conducted in English (Alpha Dog Transcriptions, Los Angeles, California). For the Spanish language session, a HIPAA compliant external service (Home Row, Inc., Henderson, Nevada) transcribed and then translated the interview and provided both transcripts to the study team side by side in order to preserve nuances in the Spanish language that could not be translated. Responses were anonymous in the transcriptions to maintain participant confidentiality. Transcripts of the focus groups were reviewed and analyzed for common patterns from which we developed codes. We coded one transcript together as a team, and then each team member coded an additional transcript themselves. We discussed the consolidated overlapping codes, deleted codes that were not representative of the data, and modified codes to reflect the data more accurately. We then modified our codebook and again applied the final codes to the transcripts ( Appendix 2 ). Participant quotes in their own words were reported consistent with previous qualitative studies.[ 8 ] Transcripts and codes were analyzed and organized using ATLAS.ti Mac (Version 9.1.3) computer-assisted qualitative analysis software (Scientific Software Development GmbH, Berlin, Germany). Results We interviewed 15 total participants who were divided into four focus groups: English-speaking adolescents (n=2), English-speaking adolescents with native Spanish-speaking parents (n=5), English-speaking parents (n=4), and primarily Spanish-speaking parents (n=4). We arrived at 10 different thematic codes that were organized into two coding families: managing and learning about opioid use for adolescents (5 codes) and brochure-specific feedback (4 codes). We also had an additional code for “good quotes”. This paper will focus on the codes that fell under the themes of managing and learning about opioid use for adolescents. Thematic analysis yielded 5 discrete themes: (1) fear of addiction, (2) feeling empowered to control opioid administration, (3) wanting alternative pain management options, (4) questioning the value of prescription opioids, and (5) learning new information about opioid safety ( Figure 1 ). Median time between surgery and the focus group was approximately two years (Range: 1–2.6y). Figure 1. Themes identified during focus groups. Open in a new tab Fear of Addiction Multiple parents in both parent focus groups expressed trepidation towards giving their adolescent prescription opioids due to fear of overdose or addiction. When asked to reflect on their experience with and previous knowledge of opioids, parents responses included, “Well, just like any drug, no one wants to be addicted to it. So I figure anything you take over two days at full-strength, you can have a issue behind it, especially if they never had nothing. So because my daughter doesn’t do anything, her system was so pure to it, she didn’t need much.” (Group conducted in English) “ I think that during adolescence is when we start to realize that there is a certain medicine that is too strong, that gets the person’s system out of control at a certain point. And that we don’t want our children to go through those situations at a certain point.” (Group conducted Spanish) Empowerment to Control Own Opioid Use Parents also endorsed feeling empowered to decide on their own when and how much opioids to give their adolescent and did not feel pressure from providers to modify their child’s opioid use. When asked if she had gotten any pushback about how much opioids they were administering to their child, a parent responded, “My doctor didn’t, he was just saying, “We have pain medication if she needs it, take it,” …Yeah, you’re right, it wasn’t a force, it was as if this is the pain medication, but if she doesn’t want to take this, then you can also give her the Tylenol and Motrin.” (Group conducted in English) When reflecting on her experience administering opioids to her daughter, another parent said, “That’s why I gave her half her pill, and I gave it to her every six hours, if needed. But I just wanted to make sure I controlled her pain, so she wouldn’t go ballistic if it ever shut off, like everything just wore off and she had nothing, then to try to get her to calm down, I didn’t want to go to that point.” (Group conducted in English) Parents also generally trusted their adolescent to tell them when pain was high enough to consider giving opioids. When asked about their decision to not administer prescribed opioid pain medication a parent reported, “Because he didn’t want to. He was afraid it would make him nauseous. And, he said that if he didn’t feel pain, he didn’t see the point in taking pain medication. I bought him Tylenol because I said: ‘Maybe a lower dose with a Tylenol.’ But he didn’t want to take it either.” (Group conduced in Spanish) Adolescents expressed trust in their parents in deciding when and how much opioids to give to them. When asked if they did any research about opioids or from what sources they learned about opioids, adolescent said, “I remember feeling fairly well-informed and … having a lot of trust in my parents as I was young. And I was like, ‘You know what? [My mom] can make the decisions. I’m just along for the ride.’ ”(Group conducted in English) However, adolescents did feel empowered to deny opioids or reduce the dosage if they were experiencing undesirable side effects or inadequate pain control. When asked how taking opioids affected their recovery, adolescent responses included, “I know one of the medicines that they prescribed; I only took that one like once. And then, I stopped. It made me like, you know, not remember things.” (Group conducted in English) “… they told me was that I only needed to use it for when I had extreme pain, but when I did take it, it actually didn’t relieve any of my pain… so I just used like what I know about being an athlete and getting injured…elevate it and just keep ice on it and to like not touch it or move it as minimal as possible.” (Speaks Spanish at home, group conducted in English) Desire for Alternatives to Prescription Opioids Adolescents and parents expressed a desire for alternative pain medications or behavioral interventions to minimize or eliminate the need for opioids. When asked how they learned about or knew how to manage their child’s pain, parent responses included, “…I tried to give her the Tylenol and Motrin instead of the [opioids]. And then after a week, then she wants to do something, so she tried to draw, and she tried to listen music, and then have a time like that. So I tried to have something to do that.” (Group conducted in English) “…when you see [your child] just lying on the couch, that’s when you say: “Oh, are you feeling bad? Shall I give you something?”…and try then hot compresses. In other words, first, looking for other methods before using the [opioid] pill, even if it’s Tylenol or Motrin. Always look for another alternative.] (Group conducted in Spanish) When asked about their experience taking opioids once they arrived home from surgery, one adolescent reported, “I only took it once and the only thing that made me feel better was just eating ice cream and that’s all.” (Speaks Spanish at home, group conducted in English) Questioning the Value of Prescription Opioids Multiple adolescents and parents endorsed a value of “not taking medication” either for themselves or in their households. When asked if they knew anyone who took opioids prior to their surgery, one adolescent said, “Every once in a while, I’ll see like my mom or my sister or somebody like take medicine for like pain or something... But me, I don’t like taking medicine at all.” (Group conducted in English) When asked if they had ever heard conflicting information about taking opioids after surgery, one parent responded, “I [got information about opioids] from my sisters. They’re both nurses, and they was like, “Do not give it to her. If you give it to her, you really monitor her.” …I’m always leery when it comes to medicine because, like I said, we don’t take medicine in the house, so I’m always questioning it when they prescribe medicine.” (Group conducted in English) New Information Learned about Opioid Safety Both adolescents and parents reported previous knowledge of opioids from sources such as internet searches, television, educational campaigns at school, and previous friends or family who had been prescribed opioids. When asked about their knowledge of opioids prior to surgery, one adolescent said, “So before surgery, all I really know that’s taught in schools, like you know, ‘Don’t do drugs. These are bad.’ ” (Group conducted in English) When asked the same question, a parent replied, “Well, I talked with a friend of mine, who also underwent back surgery, and they gave her Oxycodone, and she was getting addicted to the pill and she said that when she didn’t take it, she felt depressed, that she didn’t want to get up.” (Group conducted in Spanish) However, adolescents also reported learning new, more nuanced, information about opioids from their surgical experiences. When asked how their knowledge of opioids has changed since surgery, adolescent responses included, “I think after the surgery, I’ve become more like [attuned?] to the fact that it’s not all bad. Like it has its good uses…’Cause, I mean, they help like mitigate the pain and stuff like that.” (Group conducted in English) “For me, I thought they were supposed to be like really strong and help relieve the pain but for me I’m not sure if it’s just me or if I have like a very high tolerance to certain medications, but it didn’t really help me with like pain relief at all.” (Speaks Spanish at home, group conducted in English) There were varying recollections of the information learned from healthcare providers. When asked about whether they remember a healthcare provider educating them about opioid use after surgery an adolescent recalled, “The only thing I remember was the surgeon told me that I just had to use the medicine that was prescribed to me when I left the hospital. That’s the only thing I remember from my surgery.” (Group conducted in English) When asked the same question, one parent stated, “…I went over it with the pain team when they came in. I’m like, “Okay, tell me what you’re giving her. I want to know, and I want to know what I’m giving her.” So it was me asking questions with the pain team as well…So I feel like they were educating me.” (Group conducted in English) Discussion Recent opioid prescribing guidelines for children undergoing surgery highlight the need for qualitative research aiming to optimize education about postoperative pain management for families[ 9 ] In this qualitative study of prescription opioid use in adolescents who recently underwent surgery and their caregivers, five discrete themes based on prescription opioid use, experience, and understanding emerged. Participants reported fear of addiction from postoperative opioid use but communicated their own capacity to control opioid administration and use. They sought out alternative treatment regimens for their pain. Also, some participants reported a value of minimizing medication use in their households. Finally, while adolescents and parents reported knowledge of opioids prior to surgery from non-healthcare sources, some adolescent participants did report learning new information about opioid safety from their surgical experiences. These findings imply that adolescents and their parents are aware of the risks associated with prescription opioids and actively seek out ways to lessen prescription opioid use, if possible. However, adolescent and parent responses also demonstrate that a gap in education regarding opioid safety persists. For the practicing pediatric surgeon, these findings underscore the importance of initiating a dialogue about postoperative pain management that validates a family’s beliefs and also augments their knowledge base. As the results of this study demonstrate, the pervasiveness of the current opioid epidemic has affected many families so adolescents and their parents will likely present to their surgeon’ office with baseline opinions and impressions about prescription opioids.[ 10 ] Previous studies demonstrate that with educational interventions, caregivers can recognize signs of adverse drug events and will stop administering opioids before overdose occurs.[ 6 , 11 ] Our study found that parents in both language groups had a fear of their adolescent becoming addicted to opioids, which greatly affected how they administered opioids to their adolescents. Parents communicated a self-capacity for deciding to give their children a lower opioid dose or at a lower frequency than recommended by their physician if they felt their child was experiencing adverse effects. Parents also shortened the duration of opioid therapy and administered non-opioid or even non-pharmacologic therapies when they deemed it appropriate. Parents are not only aware of the dangers associated with prescription opioids but take it upon themselves to act to protect their children from these perceived dangers. Thus the healthcare provider’s role as educator includes more nuance than focusing on the dangers of prescription opioids and may point towards a model of shared decision making.[ 12 ] Ultimately, surgeons and healthcare workers must balance conversations with families to also underscore the benefit of properly treating pain to facilitate postoperative recovery. It is important for providers to acknowledge and understand when a patient or caregiver values minimizing medication use. Previous work highlights sociocultural factors’, such as family traditions, religious beliefs, and previous experiences with pain medications, influence on a person’s beliefs and actions regarding their experience of pain and pain medication.[ 13 , 14 ] As shown in our study, hesitance to take opioids or other medications may not always be driven by fear of addiction or overdose. For a child undergoing surgery, expanded utilization of non-pharmacologic analgesic therapies may address a family’s desire to minimize medication and the pediatric surgeon’s goal to safely manage postoperative pain.[ 15 ] Healthcare workers must keep varying values regarding medication use when recommending pain treatment plans and educating patients and their caregivers about safe prescription opioid use. Both adolescents and parents reported previous knowledge of opioids from non-healthcare sources such as acquaintances or school campaigns. Recall of the verbal opioid education given by healthcare providers varied. Providing written tools to complement verbal education helps caregivers improve pediatric postoperative patient pain control.[ 5 ] Healthcare providers should consider adopting standard printed or online resources to augment the verbal education they provide about opioids. Adolescents in our study reported that taking opioids after surgery changed their perception of the medication. Adolescents stated that now that they have recovered, they appreciate the idea that there can be benefits of using prescription opioids to facilitate recovery. While many previous educational efforts and interventions have focused on parents and caregivers, it is important not to overlook empowering adolescents about their opioid pain medication use and include them in educational efforts. Adolescents aged 15 and older comprise the majority of hospitalizations for prescription opioid poisonings in children[ 4 ] even though it has been shown that caregivers have lower medication risk perceptions regarding older children[ 16 ] and opioids are less likely to be stored safely when older children were in the household compared to younger children.[ 16 , 17 ] Education of adolescents, and not just their parents, about safe postoperative opioid use could help to mitigate adverse drug events. Our findings are subject to some limitations. We attempted to balance our recruitment for preferred language spoken and health literacy, but our study is still susceptible to selection bias in that focus groups were only conducted in two languages and available to those who could attend a focus group over several hours on a weekday. Our findings may not be generalizable to all practice settings as our cohort was relatively small and selected from patients treated at a tertiary, urban, free-standing children’s hospital. Additionally, there are likely cultural and ethnic differences the study population that impact perceptions about prescription opioid use, and medications in general, that may also limit generalizability. Additionally, these focus groups took place after the adolescents had surgery, making the results of this study susceptible to recall bias. Despite these limitations, our work contributes to the knowledge concerning decision making around use of prescription opioids for adolescents undergoing surgery and highlights future areas to address in family-centered education initiatives. Conclusion Adolescents who undergo surgery and their parents fear the potential negative consequences of prescription opioid use and feel capable of managing appropriate consumption. Consistent, evidence-based education from providers that targets both parents and adolescents could mitigate these concerns, as participants gleaned most of their knowledge of opioids from non-healthcare sources. Enhancements in patient and family education may contribute to improved pain control while promoting safe opioid use. Highlights: Little is known about families’ decision-making regarding postoperative prescription opioid consumption. Adolescents and parents are concerned about opioid side effects and risk of abuse, express self-perceived capacity to manage opioid use, and desire information on non-opioid pain management strategies. Funding/Grants: This work was supported by grant KL2TR001854 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. This work was also supported by team science grant UL1TR001855 from the Southern California Clinical and Translational Science Institute and by the University of Southern California Institute for Addiction Science institutional pilot grant funding program. The funding sources did not have a role in data collection, interpretation, or analysis, the writing of this manuscript, or the decision to submit for publication. Focus Group Script and Structure SETUP Recruit adolescents and parents who were already enrolled in our current prospective survey study of opioid use in adolescents Focus groups will occur via HIPAA compliant version Zoom and will be 2 hours long Four focus groups of six people each (6 parents, 6 adolescents, 6 parents, 6 adolescents) We will be recording video and audio for documentation purposes All information given by subjects will be de-identified and kept confidential PURPOSE Understanding gaps in opioid stewardship education for families of adolescents who require surgery Understand how healthcare providers can better educate families on opioid use, storage, and disposal consistent with published guidelines Utilize the feedback from the focus groups to generate improved educational materials on opioid stewardship for families of adolescents who require surgery, specifically addressing the needs of Spanish-speaking parents. DISCUSSIONS Discussion regarding the counselling given prior to and following their procedures regarding pain management will be conducted Perceptions and understanding of safe prescription opioid use, storage, and disposal will be measured Families will give the study team feedback on recent opioid stewardship educational tools developed by the American College of Surgeons. BACKGROUND/INTRODUCTIONS 0:00 (15 min) Probe : Community + Upbringing Please introduce yourself to the group Icebreaker:” What is something you learned about yourself this year?” “How does your family cook rice?” PREVIOUS UNDERSTANDING OF OPIOIDS 0:15 (30 min) Probe : Exposure + Use + Misconceptions regarding opioids + Family History of Use + Friends + Schools What has been your experience with opioids? How has that changed since your surgery? When did you first learn about opioids? What was your understanding of how opioids work before your surgery? Before your surgery, have you or anyone in your family used opioids? OPIOID EDUCATION AND UNDERSTANDING AFTER SURGERY 0:45 (30 min) Probe : Health literacy + Education + Current Understanding of Opioids + Health Care Provider Education After surgery, how did what you know about opioids change? Did any healthcare provider educate you on opioid use after surgery? Who counseled you on how to use the opioids you were prescribed? What were some things you learned about opioids after surgery? How did your understanding of opioids change after your surgery? Was there anything you wish you had been told about opioids that you now realize? READ/REVIEW AMERICAN COLLEGE OF SURGEONS PAMPHLET 1:15 (10 min) Please take this time to read this education tool that discuss opioid use 1:25 (20 min) Probe : Feedback + Understanding of Educational Tools + Health Literacy We are not sure if this pamphlet is helpful. If you were given this pamphlet, would you have wanted to read it? If no, why not? What are some questions you have about the information included in the pamphlet? What parts of the pamphlet are helpful? What parts of the pamphlet are confusing? What is your feedback on how this educational tool can be improved? What would you want to see in the pamphlet that would be more helpful? What is missing from the pamphlet? WRAP UP 1:45 (15 min) Final thoughts Any concerns? Any questions for us? Thematic Codes Managing and Learning about Opioid Use for Adolescents Believing in opioids or not Fearing addiction Feeling it’s up to me Uncovering knowledge on opioids Wanting Alternatives Brochure-specific Feedback Describing user-friendliness of the guide Expressing it’s not for me Learning something new Wanting a plan Other Good quote Justifying why giving opioids a a. We ultimately did not end up using this code as it overlapped significantly with several other codes Footnotes Previous Communication: This abstract was presented at the 2023 Society of Academic Surgical Congress meeting in Houston, Texas as an oral quick shot presentation. Disclosures: Declarations of interest: none Level of Evidence: IV Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. References [1]. Pruitt LCC, Swords DS, Russell KW, Rollins MD, Skarda DE. Prescription vs. consumption: Opioid overprescription to children after common surgical procedures. J Pediatr Surg 2019;54:2195–9. 10.1016/J.JPEDSURG.2019.04.013. [ DOI ] [ PubMed ] [ Google Scholar ] [2]. Horton J, Munawar S, Corrigan C, White D, Cina R. Inconsistent and excessive opioid prescribing after common pediatric surgical operations. J Pediatr Surg 2019;54:1427–31. 10.1016/J.JPEDSURG.2018.07.002. [ DOI ] [ PubMed ] [ Google Scholar ] [3]. Garren BR, Lawrence MB, McNaull PP, Sutherland R, Bukowski TP, Nielsen ME, et al. Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients. J Pediatr Urol 2019;15:260.e1–260.e7. 10.1016/J.JPUROL.2019.02.009. [ DOI ] [ PubMed ] [ Google Scholar ] [4]. Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012. JAMA Pediatr 2016;170:1195–201. 10.1001/JAMAPEDIATRICS.2016.2154. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [5]. Bailey L, Sun J, Courtney M, Murphy P. Improving postoperative tonsillectomy pain management in children--a double blinded randomised control trial of a patient analgesia information sheet. Int J Pediatr Otorhinolaryngol 2015;79:732–9. 10.1016/J.IJPORL.2015.03.003. [ DOI ] [ PubMed ] [ Google Scholar ] [6]. Voepel-Lewis T, Zikmund-Fisher B, Boyd C, Veliz P, McCabe S, Weber M, et al. Effect of a Scenario-tailored Opioid Messaging Program on Parents’ Risk Perceptions and Opioid Decision-making. Clin J Pain 2018;34:497–504. 10.1097/AJP.0000000000000570. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [7]. Odegard MN, Ourshalimian S, Hijaz D, Chen SY, Kim E, Illingworth K, et al. Factors Associated With Safe Prescription Opioid Disposal After Surgery in Adolescents. J Surg Res 2022;279:42–51. 10.1016/J.JSS.2022.05.023. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [8]. Ceasar R, Chang J, Zamora K, Hurstak E, Kushel M, Miaskowski C, et al. Primary Care Providers’ Experiences with Urine Toxicology Tests to Manage Prescription Opioid Misuse and Substance Use Among Chronic Non-Cancer Pain Patients in Safety Net Healthcare Settings. Subst Abus 2016;37:154. 10.1080/08897077.2015.1132293. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [9]. Kelley-Quon LI, Kirkpatrick MG, Ricca RL, Baird R, Harbaugh CM, Brady A, et al. Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion. JAMA Surg 2021;156:76–90. 10.1001/JAMASURG.2020.5045. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [10]. Hswen Y, Zhang A, Freifeld C, Brownstein JS. Evaluation of Volume of News Reporting and Opioid-Related Deaths in the United States: Comparative Analysis Study of Geographic and Socioeconomic Differences. J Med Internet Res 2020;22(7)E17693 Https//WwwJmirOrg/2020/7/E17693 2020;22:e17693. 10.2196/17693. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [11]. Voepel-Lewis T, Zikmund-Fisher B, Smith E, Redman R, Zyzanski S, Tait A. Parents’ Analgesic Trade-Off Dilemmas: How Analgesic Knowledge Influences Their Decisions to Give Opioids. Clin J Pain 2016;32:187–95. 10.1097/AJP.0000000000000137. [ DOI ] [ PubMed ] [ Google Scholar ] [12]. Loeff DS, Shakhsheer BA. The ethics of informed consent and shared decision-making in pediatric surgery. Semin Pediatr Surg 2021;30:151101. 10.1016/J.SEMPEDSURG.2021.151101. [ DOI ] [ PubMed ] [ Google Scholar ] [13]. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Http://DxDoiOrg/102217/Pmt127 2012;2:219–30. 10.2217/PMT.12.7. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [14]. Givler A, Bhatt H, Maani-Fogelman PA. The Importance Of Cultural Competence in Pain and Palliative Care. StatPearls 2022. [ PubMed ] [ Google Scholar ] [15]. Wente SJK. Nonpharmacologic pediatric pain management in emergency departments: a systematic review of the literature. J Emerg Nurs 2013;39:140–50. 10.1016/J.JEN.2012.09.011. [ DOI ] [ PubMed ] [ Google Scholar ] [16]. McDonald EM, Kennedy-Hendricks A, McGinty EE, Shields WC, Barry CL, Gielen AC. Safe Storage of Opioid Pain Relievers Among Adults Living in Households With Children. Pediatrics 2017;139. 10.1542/PEDS.2016-2161. [ DOI ] [ PubMed ] [ Google Scholar ] [17]. Sloss K, Vargas G, Brummett C, Englesbe M, Waljee J, Adepalli S, et al. Association of caregiver-reported education with locked storage and disposal of prescription opioids after children’s surgery. J Pediatr Surg 2020;55:2442–7. 10.1016/J.JPEDSURG.2020.04.022. [ DOI ] [ PubMed ] [ Google Scholar ] ACTIONS View on publisher site PDF (299.4 KB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top