Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE)

疼痛中的沟通和激活，以加强关系并公平地治疗疼痛（合作）

• 批准号: 10213832
• 负责人: Marianne Matthias
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213832
• 关键词: Address; Affect; American; Area; Benefits and Risks; Caring; Clinic; Clinic Visits; Clinical; Cognition; Communication; Communication Methods; Effectiveness; Enrollment; Evaluation; Exhibits; Goals; Health; Health Personnel; Healthcare; Individual; Intervention; Intervention Studies; Intervention Trial; Interview; Knowledge; Lead; Life Style; Light; Link; Mediating; Mediator of activation protein; Medical; Medical Care Costs; Minority; Mission; Opioid; Outcome; Outcome Study; Pain; Pain Clinics; Pain intensity; Pain interference; Pain management; Participant; Patients; Primary Health Care; Productivity; Provider; Qualitative Methods; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research Design; Research Priority; Safety; Self Efficacy; Self Management; Sleep; Specialist; Substance abuse problem; Symptoms; Telephone; Testing; Urine; Veterans; Work; arm; attentional control; black patient; chronic musculoskeletal pain; chronic pain; cost; design; disability; drug testing; effectiveness testing; ethnic minority population; experience; health care disparity; health care settings; health equity; health management; hybrid type 1 study; implementation barriers; implementation facilitators; improved; innovation; minority health; neglect; patient-clinician communication; primary endpoint; primary outcome; psychologic; racial and ethnic; racial disparity; racial minority; recruit; skills

Background: Chronic pain affects 40-70% of Veterans and amounts to over $600 billion/year in direct medical costs and lost worker productivity. Racial disparities in pain treatment have been extensively documented. Minority patients, including Veterans, are more likely to be undertreated for pain. Minority Veterans have pain documented less frequently, undergo more urine drug tests, and are more likely to be referred for substance abuse evaluation than White Veterans. Compounding these pain care disparities, minority Veterans exhibit lower levels of patient activation than Whites. Patient activation—having knowledge, confidence, and skills to manage health—is associated with better health experiences, self-management, and outcomes. Low activation is frequently manifested in poorer communication among minority patients. Minority patients are less likely to share their concerns with providers, ask questions, and prepare for their clinic visits. This poor communication is associated with lower quality care, poorer patient-provider relationships, and treatment non-adherence. The poorer communication experienced by minorities is exacerbated by the documented difficulties in patient- provider communication about chronic pain and its treatment—particularly where opioids are concerned. Objectives: COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) is a pragmatic randomized controlled trial of an intervention to improve patient activation and communication with providers for Black Veterans with chronic pain. COOPERATE focuses on 2 essential skill sets necessary to facilitate effective patient activation: 1) goal-setting and prioritization, and 2) communication skills. COOPERATE is delivered over the telephone in 6 sessions (4 weekly sessions followed by 2 booster session) over a period of 12 weeks. The primary study outcome is patient activation. Methods: COOPERATE is a Hybrid Type 1 study, designed to test effectiveness while also examining implementation facilitators and barriers. COOPERATE will enroll 250 Black Veterans with chronic musculoskeletal pain from primary care clinics. Veterans will be randomized either to the COOPERATE intervention or to an attention control arm. For Aim 1 we will test the effects of COOPERATE at 3 (primary end point), 6, and 9 months (sustained effects) on patient activation (primary outcome), communication self- efficacy, pain intensity and interference, and psychological functioning. Aim 2 will examine patient activation as a mediator of clinical outcomes, and working alliance as a moderator of COOPERATE’s effect on patient activation. In Aim 3, our pre-implementation aim, we will use qualitative methods to understand facilitators and barriers to implementing COOPERATE. Guided by the RE-AIM framework, we will interview a purposefully selected subsample of intervention Veterans, and clinicians from primary care and the chronic pain clinic, to better prepare for COOPERATE’s implementation. Innovation: COOPERATE focuses on two important, yet frequently neglected, areas for improvement in minority health: patient activation and communication. This is especially important in chronic pain care, since numerous treatment options with a wide range of risks and benefits exist, and since minorities are offered fewer of these pain treatment options. Helping minority Veterans to become more active in their care is critical for improving chronic pain care. This is especially important in light of VA efforts such as the Opioid Safety Initiative, designed to improve safety for Veterans, but which also require engaged, active patients as Veterans must explore alternative pain treatments with their providers—treatments that are feasible for Veterans’ individual lifestyles and consistent with their symptom priorities and treatment goals.

背景：慢性疼痛影响着 40-70% 的退伍军人，直接医疗费用每年超过 6000 亿美元 疼痛治疗的成本和工人生产力的下降已被广泛记录。 包括退伍军人在内的少数族裔患者更有可能因疼痛而得不到充分治疗。 记录频率较低，接受更多尿液药物测试，并且更有可能转诊以获取物质 少数族裔退伍军人表现出与白人退伍军人相比的虐待评估，这加剧了这些疼痛护理差异。 患者的激活水平低于白人——患者有知识、信心和技能。 管理健康——与更好的健康体验、自我管理和结果相关。 通常表现为少数族裔患者沟通较差。 与提供者分享他们的担忧，提出问题，并为他们的诊所就诊做好准备。 与较低质量的护理、较差的医患关系以及不依从治疗有关。 少数族裔所经历的较差的沟通因患者在治疗过程中遇到的困难而加剧。 提供者关于慢性疼痛及其治疗的沟通——特别是在阿片类药物方面。 目标：合作（疼痛中的沟通和激活，以加强关系和治疗疼痛 with Equity）是一项实用的随机对照试验，旨在提高患者的积极性和干预措施 与患有慢性疼痛的黑人退伍军人的提供者的沟通重点关注 2 项基本技能。 促进有效患者激活所需的设置：1) 目标设定和优先顺序，以及 2) 沟通 合作技能通过电话分 6 次进行（每周 4 次，随后是 2 次加强课程）。 为期 12 周的主要研究结果是患者激活。 方法：COOPERATE 是一项混合 1 型研究，旨在测试有效性，同时也检查 实施促进者和障碍者将招募 250 名患有慢性病的黑人退伍军人。 来自初级保健诊所的肌肉骨骼疼痛的退伍军人将被随机分配到合作组。 对于目标 1，我们将测试合作在 3 处的效果（主要目的）。 点）、6 个月和 9 个月（持续影响）对患者激活（主要结果）、自我沟通 目标 2 将检查患者的激活程度、疗效、疼痛强度和干扰以及心理功能。 临床结果的调节因素，工作联盟作为合作对患者影响的调节因素 在目标 3（我们的实施前目标）中，我们将使用定性方法来了解促进者和促进者。 在 RE-AIM 框架的指导下，我们将有目的地采访一个人。 从初级保健和慢性疼痛诊所中选择干预退伍军人和士兵的子样本，以 更好地为 COOPERATE 的实施做好准备。 创新：COOPERATE 重点关注两个重要但经常被忽视的改进领域 少数群体健康：患者激活和沟通这在慢性疼痛护理中尤其重要，因为 存在多种具有广泛风险和益处的治疗方案，并且由于向少数群体提供 帮助少数族裔退伍军人更加积极地进行护理至关重要。 鉴于阿片类药物安全等 VA 的努力，这一点尤其重要。 倡议旨在提高退伍军人的安全，但也需要退伍军人积极主动的参与 必须与他们的提供者一起探索替代性疼痛治疗方法——对退伍军人来说可行的治疗方法 个人生活方式并与其症状优先顺序和治疗目标保持一致。