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: 9927912
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9927912
• 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; Hybrids; 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; Reporting; Research Design; Research Priority; Safety; Self Efficacy; Self Management; Sleep; Specialist; Substance abuse problem; Symptoms; Telephone; Testing; Urine; Veterans; Work; arm; attentional control; 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; 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40-70％的退伍军人，直接医疗/年超过6000亿美元 成本和失去工人的生产力。疼痛治疗中的种族分布已被广泛记录。 包括退伍军人在内的少数族裔患者更有可能因疼痛而被低估。少数退伍军人有痛苦 记录的频率较低，接受更多的尿液药物测试，并且更有可能被转介给底物 滥用评估比白人退伍军人。少数退伍军人展示了这些疼痛护理分布 患者激活水平低于白人。患者激活 - 具有知识，信心和技能 管理健康 - 与更好的健康经验，自我管理和结果有关。低激活 经常表现在少数族裔患者之间的沟通较差。少数族裔患者不太可能 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准备。这种不良的沟通 与质量较低的护理，患者提供者的关系较差以及不遵守治疗有关。这 少数群体的沟通经历较差会因记录的患者困难而加剧 - 提供者关于慢性疼痛及其治疗的沟通 - 尤其是阿片类药物的地方。 目标：合作（痛苦中的沟通和激活以增强人际关系和治疗痛苦 具有公平性）是一项务实的随机对照试验，用于改善患者激活和 与慢性疼痛的黑人退伍军人提供者交流。合作专注于2个基本技能 促进有效患者激活所必需的集合：1）目标设定和优先级； 2）交流 技能。合作在6次会议中通过电话交付（每周4次会议，然后是2个助推器 会议）在12周内。主要研究结果是患者的激活。 方法：合作是一项混合1型研究，旨在测试有效性，同时还检查 实施促进者和障碍。合作将与250名黑人退伍军人一起与慢性 初级保健诊所的肌肉骨骼疼痛。退伍军人将被随机分配给合作 干预或注意力控制臂。对于目标1，我们将测试3（主要端）合作的效果 点），6和9个月（持续影响）对患者激活（主要结果），交流自我 AIM 2将检查患者的激活是有效性，疼痛强度和干扰以及心理功能。 临床结果的调解人，并与合作对患者的影响的主持人合作 激活。在AIM 3中，我们的实施前目标，我们将使用定性方法来了解促进者和 实施合作的障碍。在Re-Aim框架的指导下，我们将有目的地采访 干预退伍军人的选定子样本，以及初级保健和慢性疼痛诊所的临床医生 最好准备合作的实施。 创新：合作着重于两个重要但经常被忽视的领域，以改进 少数民族健康：患者激活和沟通。这在慢性疼痛护理中尤其重要，因为 存在许多具有广泛风险和福利的治疗选择，并且由于提供少数群体 这些疼痛治疗选择中的更少。帮助少数派退伍军人在护理中更加活跃至关重要 用于改善慢性疼痛护理。鉴于阿片类药物安全等VA努力，这一点尤其重要 倡议，旨在提高退伍军人的安全性，但还需要参与活跃的患者作为退伍军人 必须与提供者探索替代性疼痛治疗 - 对退伍军人的可行处理 个人生活方式，符合其症状的重点和治疗目标。