Table 2.

3 × 3 Matrix Outlining the Interaction between Behavioural Determinants of Opioid Prescribing

	Beliefs about Capabilities The physician’s belief of the truth or reality about their ability, talent, or facility that they can put to constructive use.	Behavioural Regulation Anything aimed at managing or changing [the physician’s own] objectively observed or measured actions.	Professional Role & Identity A coherent set of behaviours and displayed personal qualities of the physician in their work setting.
Beliefs about Consequences The physician’s beliefs of the truth, reality, or validity about outcomes of their behaviour [or the behaviour of their patients] in a given situation.	-Confidence in prescribing was influenced by individual beliefs about the risks and benefits of opioids -Limited evidence, the prevalence of chronic pain, and street supply leads FPs feeling that there is very little they can do	-Numerous unsuccessful experiences led to the belief that existing strategies were not sufficient to achieve guideline concordant care -Most FPs use a stepwise approach to pain management that aligns with guidelines, however this approach is grossly undermined by a lack of access or long waiting lists	-Tensions emerged between the FPs role as a “healer” who provides symptomatic relief and the need to avoid adverse consequences -Challenging conversations around opioid prescribing and pain management threaten the therapeutic relationship
Environmental Context and Resources Any circumstance of a physician’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour.	-Poor access to mental health and addiction services and alternatives to pain management create a barrier to appropriately managing pain -Recent guidelines often had a neutral or negative influence on confidence in prescribing due to generally weak recommendations	-The system lacks effective resources to support FPs in monitoring opioid prescribing in their practice -Guidelines do not provide actionable suggestions for behaviours within the FPs immediate control (i.e., dose equivalent substitutions)	-Poor communication by specialists impedes the FPs ability to determine the appropriateness of extending certain prescriptions -The role of FPs vs. other prescribers in the system with respect to opioid prescribing and pain management are unclear, meaning that management often gets “dumped on” the FP
Emotion A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the physician attempts to deal with a personally significant matter or event.	-Emotionally charged conversations with patients around pain management lead FPs to question whether they did the right thing -FPs do not feel equipped to navigate these conversations, creating a sense of anxiety in anticipation of these discussions -The perception of strong therapeutic relationships was perceived to diffuse emotional tensions and facilitate easier conversations	-FPs felt frustrated because there is minimal success in their strategies -Emotional consequences led some FPs to avoid prescribing as a mechanism to avoid these challenging conversations -There are currently no resources to help FPs diffuse the emotional tension that arises in challenging conversations	-Tensions around opioid prescribing and the need to police patients makes FPs feel terrible for not meeting their patients’ perceived needs -The FPs role as a “healer” is at odds with their role in provide guideline-concordant care, resulting in a range of conflicting emotions

FP family physician