COVID-19 Impact on Pain management: Highlighting, Explaining, and Realigning services (CIPHER)

COVID-19 对疼痛管理的影响：突出显示、解释和重新调整服务 (CIPHER)

• 批准号: 10673419
• 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: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10673419
• 关键词: Area; Attitude; Belief; COVID-19; COVID-19 impact; COVID-19 pandemic; Caring; Chronic low back pain; Code; Cognitive; Cognitive Science; Collaborations; Communities; Data; Development; Environment; Equity; Evaluation; Event; Feedback; Film; Funding; Future; Gender identity disorder; Goals; Healthcare; Healthcare Systems; High Prevalence; Hour; Indiana; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); Interruption; Intervention; Interview; Knowledge; Learning; Lesbian Gay Bisexual Transgender Queer; Life Experience; Literature; Low Back Pain; Measures; Medical; Mental Health; Methodology; Methods; Neurologic; Opioid; Pain; Pain management; Patients; Perception; Performance; Personal Satisfaction; Persons; Play; Population; Prevalence; Provider; Questionnaires; Recommendation; Reporting; Research Personnel; Resistance; Respondent; Risk; Sampling; Services; Substance Use Disorder; Surveys; Testing; Transcript; Translating; Translations; Universities; Veterans; Violence; Work; acceptability and feasibility; catalyst; chronic pain; chronic painful condition; cisgender; cohort; comorbidity; disorder risk; experience; gender diversity; health care disparity; improved; innovation; meetings; member; novel; opioid overdose; opioid use; overdose risk; pandemic disease; physical conditioning; post-COVID-19; prescription opioid; prevent; primary care provider; programs; response; social stigma; transgender

Background: Transgender and gender diverse (TGD) Veterans are a priority population at greater risk of harm following disruptions in chronic pain care, with higher rates of chronic pain conditions and of physical and mental health comorbidities associated with prescription opioid use and overdose risk. Moreover, TGD Veterans avoid medical care due to negative experiences rooted in stigma, reporting “insensitivity, harassment, and violence” and “a general lack of knowledge about transgender patients and care among providers.” Significance: Both the higher rates of chronic pain conditions and the increased prevalence of SUD and overdose risk underscore that consistent chronic pain care and close oversight of care plans are essential for TGD Veterans, and interruptions may have dire consequences. The need to better understand and develop strategies to improve chronic pain care for TGD Veterans is critical and urgent to support wellbeing, manage pain, ameliorate discriminatory treatment rooted in provider biases, and prevent opioid-related crises. Innovation and Impact: Identity Development Evaluation and Sharing (IDEAS) is an innovative, evidence- supported methodology in which qualitative data are presented via theatricalized, filmed monologues. Studies have shown that viewing an IDEAS performance significantly reduces stigma beliefs, and literature suggests IDEAS may facilitate translation of qualitative findings into actionable recommendations for optimizing future care because data are presented in deeply contextualized ways – embedded in Veterans’ life experiences. Specific Aims: The proposed work will supplement an existing VA-funded study, CIPHER, which focuses on 1) understanding changes in Veterans’ chronic low-back pain care after COVID-19 and their associated impacts; and 2) using these data to develop strategies to optimize future delivery of VA pain services. Aim 1 of the proposed work will enhance CIPHER by elucidating chronic pain care experiences of a high priority population, TGD Veterans. In aim 2 of the proposed work we will apply findings from Aim 1 to develop a novel, interactive intervention to support equitable TGD Veteran care, advancing CIPHER’s aim of developing short and long-term strategies to optimize equitable delivery of pain management services post-COVID-19. Methodology: In aim 1 we will purposefully sample TGD Veterans from CIPHER’s cohort of Veterans with chronic low back pain use ICD-10 Gender Identity Disorder codes. We will conduct narrative interviews to learn about TGD Veterans’ chronic pain care experiences prior to and following the onset of the pandemic. We will identify key messages via thematic analysis of interview transcripts, focusing especially on areas for future care optimization. In aim 2 we will apply IDEAS to produce a 25-minute film with professional actors portraying key messages from aim 1 findings. We will share the film with CIPHER stakeholders and primary care providers during a 1-hour meeting in which TGD Veteran panelists join for a 15-minute PI-moderated post-film panel conversation. Stakeholders and providers will complete a pre/post Acceptance and Action Questionnaire – Stigma, which provides a composite score with lower scores indicating reduced enacted stigma. An unadjusted two sample paired t-test will be used to assess the difference in matched pre-post AAQ-S survey scores. To assess whether IDEAS feasibly and acceptably shares qualitative data to facilitate actionable change, we will distribute the Acceptability of Intervention Measure (AIM) and the Feasibility of Intervention Measure (FIM) anonymously via an online survey that will include space for open-ended responses with each item, asking respondents to describe if/how IDEAS facilitates actionable change. We will use explanatory sequential mixed methods to expand quantitative AIM/FIM findings with qualitative feedback. Next steps/Implementation: The proposed work will result in an IDEAS film depicting chronic pain care experiences of TGD Veterans that can be disseminated by CIPHER stakeholders, as well as data on pre/post change in provider stigma and stakeholders’ perceptions of IDEAS feasibility and acceptability.

背景：跨性别和性别多样性（TGD）退伍军人是一个优先考虑的人群，受到伤害的风险更大 在慢性疼痛护理中断后，慢性疼痛状况和身体和 与处方阿片类药物使用和过量风险相关的精神健康共病。此外，TGD 退伍军人避免医疗保健，由于负面的经验植根于耻辱，报告“不敏感，骚扰， 和暴力”以及“对变性患者和提供者的护理普遍缺乏了解”。 意义：慢性疼痛状况的发生率较高，SUD患病率增加， 过量风险强调了持续慢性疼痛护理和密切监督护理计划对于 TGD退伍军人，中断可能会产生可怕的后果。需要更好地理解和发展 改善TGD退伍军人慢性疼痛护理的策略对于支持健康，管理 疼痛，改善根源于提供者偏见的歧视性待遇，并预防与阿片类药物有关的危机。 创新和影响：身份发展评估和共享（IDEAS）是一个创新的，证据- 支持的方法，其中定性数据是通过戏剧化，拍摄独白。研究 研究表明，观看IDEAS的表现可以显著降低污名信念，文献表明， IDEAS可以促进将定性结果转化为可操作的建议，以优化未来 护理，因为数据是以深刻的背景方式呈现的-嵌入在退伍军人的生活经历中。 具体目标：拟议的工作将补充现有的VA资助的研究，CIPHER，重点是 1)了解COVID-19后退伍军人慢性腰痛护理的变化及其相关的 影响;和2）使用这些数据来制定策略，以优化VA疼痛服务的未来交付。目标1 拟议的工作将通过阐明高度优先的慢性疼痛护理经验来加强CIPHER TGD退伍军人。在拟议工作的目标2中，我们将应用目标1的发现来开发一种新的， 互动干预，以支持公平的TGD退伍军人护理，推进CIPHER的目标， 以及优化COVID-19后疼痛管理服务公平交付的长期战略。 方法：在目标1中，我们将有目的地从CIPHER的退伍军人队列中抽样TGD退伍军人， 慢性腰痛使用ICD-10性别认同障碍代码。我们将进行叙述式访谈， 关于TGD退伍军人的慢性疼痛护理经验之前和之后的大流行病。我们将 通过对访谈记录进行专题分析，确定关键信息，特别侧重于今后的工作领域 护理优化在目标2中，我们将运用IDEAS制作一部25分钟的电影，由专业演员扮演 目标1调查结果的关键信息。我们将与CIPHER利益相关者和初级保健分享这部电影 在一个小时的会议期间，TGD资深小组成员参加了一个15分钟的PI主持的后期电影 小组讨论。利益相关方和提供商将完成一份接受和行动前/后问卷 - 耻辱，提供综合评分，评分较低表明所实施的耻辱减少。一个 将使用未调整的双样本配对t检验评估匹配的前后AAQ-S调查的差异 成绩.评估IDEAS是否可行和可接受地共享定性数据，以促进可操作性 改变，我们将分发干预措施的可接受性（AIM）和干预的可行性 通过在线调查进行匿名测量，该调查将包括每个开放式回答的空间 项目，要求受访者描述IDEAS是否/如何促进可行的变革。我们将使用解释性 序贯混合方法，以扩大定量AIM/AIM结果与定性反馈。 下一步/实施：拟议的工作将产生一个描述慢性疼痛护理的IDEAS电影 CIPHER利益相关者可以传播的TGD退伍军人的经验，以及关于前/后的数据 改变提供者的耻辱感和利益相关者对IDEAS可行性和可接受性的看法。