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

针对女性退伍军人疼痛自我管理的障碍：新型同伴支持干预措施的完善和可行性（CONNECT 项目）

• 批准号: 10415882
• 负责人: Mary Driscoll
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10415882
• 关键词: Address; Adherence; Adoption; Behavior Therapy; Behavioral; Caring; Child Rearing; Chronic; Clinical; Clinical Research; Cognitive Therapy; Complex; Coping Skills; Data Collection; Disadvantaged; Education; Enrollment; Evaluation; Feedback; Funding; Future; Gender; Glean; Goals; Gold; Health; Health Policy; Health Psychology; Health Services Accessibility; Health Services Research; Healthcare; Home; Improve Access; Individual; Informatics; Intervention; Interview; Knowledge; Learning; Logistics; Measures; Methodology; Methods; Morbidity - disease rate; Motivation; Outcome; Pain; Pain Research; Pain intensity; Pain management; Participant; Patients; Perception; Persons; Pharmaceutical Preparations; Population; Preparation; Provider; Psychologist; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Regimen; Reporting; Research; Research Personnel; Research Training; Resources; Sampling; Self Management; Social support; Surveys; Targeted Research; Testing; Training; Translating; Transportation; Veterans; Woman; Women' s Health; Work; acceptability and feasibility; analog; arm; base; career; chronic musculoskeletal pain; chronic pain; chronic pain management; cost; cost effective; depressive symptoms; design; effectiveness trial; emotional distress; evidence base; feasibility testing; gender preference; health care delivery; hybrid type 1 trial; implementation determinants; improved; improved outcome; innovation; interpersonal trauma; male; men; novel; pain self-management; patient oriented; peer; peer support; physically handicapped; pilot test; preference; programs; prospective; psychosocial; randomized effectiveness trial; randomized trial; recruit; satisfaction; self-management program; social factors; success; uptake; walking program; willingness

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.

背景。女性是退伍军人医疗管理局（VA）使用者中增长最快的群体。