The impact of opioid stigma on patient-provider interaction and decision-making in cancer pain management: a qualitative meta-synthesis.

CONTEXT: Clinical guidelines recommend opioids for moderate-to-severe cancer pain, yet undertreatment remains common. In the context of the opioid crisis and increasingly restrictive regulatory policies, communication and decision-making around cancer pain management have become more challenging. Opioid stigma may be an overlooked influence on how patients and healthcare providers communicate and make treatment decisions.

OBJECTIVES

To explore how opioid stigma influences patient-provider interaction and decision-making through a qualitative meta-synthesis.

METHODS

This qualitative meta-synthesis followed PRISMA and ENTREQ and was registered in PROSPERO (CRD420261329320). We searched PubMed, CINAHL, Embase, PsycINFO, Web of Science, the Cochrane Library, WanFang, and CNKI from database inception to 1 March 2026. We included qualitative studies examining stigma, interaction, and decision-making in cancer pain management. Findings were synthesized using thematic synthesis, and confidence was assessed using CERQual.

RESULTS

Twenty studies were included. Most had moderate methodological limitations, particularly in reflexivity and positionality. A total of 145 findings were extracted and grouped into 10 descriptive categories and 4 analytical themes. Opioid stigma was shaped by sociocultural narratives and institutional processes. Patients internalized this stigma as shame and fear, which could reduce pain expression and help-seeking. Clinicians faced tension between adequate analgesia and risk management, contributing to conservative prescribing. In clinical encounters, patients often felt compelled to justify the legitimacy of their pain, whereas clinicians responded defensively to perceived risks.

CONCLUSIONS

Opioid stigma shapes patient-provider interaction and decision-making in cancer pain management and may reinforce undertreatment. Multilevel efforts to reduce stigma may improve communication, support shared decision-making, and promote more appropriate opioid-related decision-making in cancer pain management.