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\begin{document}

\title{A review of trial and real-world data applying a realist approach to
identify behavioural mechanisms supporting practitioners to taper
opioids}



\author[1]{Debi BHATTACHARYA}%
\author[2]{Hattie Whiteside}%
\author[2]{Emma Tang}%
\author[2]{Kumud Kantilal}%
\author[2]{Yoon Loke}%
\author[2]{Bethany Atkins}%
\author[2]{Caroline Hill}%
\affil[1]{University of Leicester College of Life Sciences}%
\affil[2]{University of East Anglia}%


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  \date{May 18, 2024}


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\begin{abstract}
This realist enquiry applying behavioural theory aimed to identify
behavioural mechanisms and contexts that facilitate prescribers tapering
opioids. We identified relevant opioid tapering interventions and
services from a 2018 international systematic review and a 2019
England-wide survey, respectively. Interventions and services were
eligible if they provided information about contexts and/or behavioural
mechanisms influencing opioid tapering success. A stakeholder group
(n=23) generated draft programme theories based around the 14 domains of
the theoretical domains framework. We refined these using the trial and
service data. From 71 articles and 21 survey responses, 56 and 16
respectively were included, representing primary care, hospital,
specialist pain facilities and prison services. We identified six
programme theories that included five behavioural mechanisms:
prescribers' knowledge about how to taper; build prescribers' beliefs
about capabilities to initiate tapering discussions and manage
psychological consequences of tapering; perceived professional role in
tapering; the environmental context enabling referral to specialists;
and facilitating positive social influence by aligning patient:
prescriber expectations of tapering. No interventions are addressing all
six mechanisms supportive of tapering. Work is required to
operationalise programme theories according to organisational structures
and resources. An example operationalisation is combining tapering
guidelines with information about local excess opioid problems and
endorsing these with organisational branding. Prescribers being given
the skills and confidence to initiate tapering discussions by training
them in cognitive-based interventions and incorporating access to
psychological and physical support in the patient pathway. Patients
being provided with leaflets about the tapering process and informed
about the patient pathway.%
\end{abstract}%



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