Targeting Barriers to Pain Self-Management in Women Veterans: Refinement and Feasibility of a Novel Peer Support Intervention (Project CONNECT)

背景资料。女性是退伍军人医疗管理局(VA)使用者中增长最快的部分。 尽管男性和女性退伍军人都报告慢性疼痛的比例很高，但女性的比例更高。 解决他们的独特需求是当务之急。退伍军人管理局再次强调促进自我管理 止痛。尽管有一个广泛支持的项目来这样做，认知行为疗法对慢性疼痛 (CBT-CP)，指出了获得这种护理并以最佳方式实施其建议的几个障碍 对于女性来说，这一点可能尤为突出。这些包括后勤、医疗保健服务和 心理社会障碍。以患者为中心的努力在循证疼痛的背景下解决这些问题 像CBT-CP这样的干预措施可能会改善治疗的可及性、参与度、依从性等 女性退伍军人的最佳结果。因此，以家庭为基础的干预结合了证据- 基于对等支持(RPS)的CBT-CP计划已经开发(CONNECT)，目前 是一名飞行员。结果是有希望的，但在 全面试验是有必要的。这项建议将优化互联互通的可行性和可接受性 为未来的随机试验检查候选对照条件的潜在可行性。 重要性/影响：因为Connect比CBT-CP占用的资源少，而且是因为它是家 在此基础上，它可能会降低成本并改善获得行为疼痛护理的机会，它的成功可能会产生影响 对于有疼痛的男性退伍军人来说。它的目标是以前未解决的和潜在可修改的因素(例如 支持)被认为与女性退伍军人的疼痛自我管理的调整和吸收有关。 创新：Connect研究了一种推广CBT-CP的替代方法，该方法具有潜在的可扩展性、成本- 有效且可运输。具体目标：目标1a。征求退伍军人对精细化招聘的反馈意见 战略、治疗组成部分和材料、持续时间/内容、参与战略、同行匹配和 数据收集方法。目标1b。评估可行性(保留、遵守、评估方法、 改进的8周RPS疼痛自我管理的可接受性(可信度、满意度) 对30名患有慢性肌肉骨骼疼痛的退伍军人进行干预(CONNECT)。目标1c： 进行应答者分析，对临床证据的女性退伍军人的百分比进行分类 疼痛强度/干扰和抑郁症状的有意义的改善。目标2：使用定性方法 A)检查参与者对连接的满意度/可接受性的看法以及 具体组成部分，以及b)检查参与者对基本机制的看法。目标3：正在准备中 对于未来的随机对照试验(RCT)，进行可行性分析以确定优先选择 使用预期偏好评估进行治疗，其中包括a)质化访谈以提出质疑 参与未来随机对照研究和调查的动机、关注和影响因素 评估b)是否愿意随机选择候选控制条件的措施，以及c)影响因素 他们的意愿。方法：单臂试验设计和模拟研究，以检验 随机化到候选控制条件。后续步骤/实施。如果连接可行，则使用混合 第1类试验将得到保证，以确定提供商是否可以自信地建议连接到 妇女退伍军人和审查执行因素。

Background. Women are the fastest-growing segment of Veterans Healthcare Administration (VA) utilizers. Although men and women Veterans both report high rates of chronic pain, rates are higher in women. Addressing their unique needs is a priority. VA has placed renewed emphasis on promoting self-management for pain. Despite having a widely supported program for doing so, cognitive behavioral therapy for chronic pain (CBT-CP), several barriers to accessing this care and engaging optimally with its recommendations are noted and these may be particularly salient for women. These include logistical, healthcare delivery, and psychosocial barriers. Patient-centered efforts to address these in the context of evidence-based pain interventions, like CBT-CP, may translate to improved treatment access, engagement, adherence, and more optimal outcomes for women Veterans. Accordingly, a home-based, intervention integrating an evidence- based CBT-CP program with reciprocal peer support (RPS) has been developed (CONNECT) and is currently being pre-piloted. Results are promising but substantial refinement and feasibility testing is warranted before a full-scale trial is warranted. This proposal will optimize the feasibility and acceptability of CONNECT and examine the potential feasibility of candidate control conditions for a future randomized trial. Significance/Impact: Because CONNECT is less resource-intensive than CBT-CP and because it is home based, it may reduce costs and improve access to behavioral pain care, and its success may have implications for male Veterans with pain. It targets previously unaddressed and potentially modifiable factors (e.g. social support) thought to be relevant for adjustment and uptake of pain self-management among women Veterans. Innovation: CONNECT examines an alternate method for promoting CBT-CP that is potentially scalable, cost- effective and transportable. Specific Aims: Aim 1a. Solicit Veteran feedback on the refined recruitment strategies, treatment components and materials, duration/content, engagement strategies peer-matching and data collection methods. Aim 1b. Evaluate the feasibility (retention, adherence, assessment methods, recruitment rate) and acceptability (credibility, satisfaction) of a refined 8-week RPS pain self-management intervention (CONNECT) in a sample of 30 women Veterans with chronic musculoskeletal pain. Aim 1c: Conduct a responder analysis to classify the percentage of women Veterans that evidence clinically meaningful improvements in pain intensity/interference and depressive symptoms. Aim 2: Use qualitative methodology to a) examine participant perceptions regarding satisfaction/acceptability of CONNECT, and of specific components, and b) examine participant perceptions of underlying mechanisms. Aim 3: In preparation for a future randomized-controlled trial (RCT), conduct a feasibility analysis to determine preferences for treatment using the prospective preference assessment, which includes a) qualitative interviews to query motivations for, concerns about and factors influencing participation in a future RCT as well as survey measures to assess b) willingness to be randomized to candidate control conditions, and c) factors influencing their willingness. Methodology: A single arm pilot design and an analogue study to examine the feasibility of randomization to candidate control conditions. Next Steps/Implementation. If CONNECT is feasible a Hybrid Type 1 trial will be warranted to determine whether providers may confidently recommend CONNECT to women Veterans and to examine implementation factors.