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：跨性别和性别多样化 (TGD) 退伍军人是受到更大伤害风险的优先人群 慢性疼痛护理中断后，慢性疼痛状况以及身体和精神疾病的发生率更高 与处方阿片类药物使用和过量风险相关的心理健康合并症。此外，TGD 退伍军人由于源于耻辱的负面经历而避免接受医疗护理，他们报告说“麻木不仁、骚扰、 和暴力”以及“普遍缺乏对跨性别患者和提供者护理的了解”。 意义：慢性疼痛的发病率较高，SUD 和 SUD 的患病率也较高。 过量风险强调持续的慢性疼痛护理和对护理计划的密切监督对于 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福祉、管理 疼痛，改善源于医疗服务提供者偏见的歧视性待遇，并预防与阿片类药物相关的危机。 创新和影响：身份发展评估和共享（IDEAS）是一项创新的、循证的 支持的方法论通过戏剧化的电影独白来呈现定性数据。研究 研究表明，观看 IDEAS 表演可以显着减少耻辱感，文献表明 IDEAS 可以促进将定性发现转化为优化未来的可行建议 之所以关心，是因为数据以深度情境化的方式呈现——嵌入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，该研究的重点是 1) 了解 COVID-19 后退伍军人慢性腰痛护理的变化及其相关 影响； 2) 使用这些数据制定策略以优化未来 VA 疼痛服务的提供。目标 1 的 拟议的工作将通过阐明高度优先的慢性疼痛护理经验来增强 CIPHER 人口，TGD 退伍军人。在拟议工作的目标 2 中，我们将应用目标 1 的发现来开发一部小说， 互动干预支持公平的 TGD 退伍军人护理，推进 CIPHER 发展短期目标的目标 以及优化 Covid-19 后公平提供疼痛管理服务的长期战略。 方法：在目标 1 中，我们将有目的地从 CIPHER 退伍军人队列中抽取 TGD 退伍军人 慢性腰痛使用 ICD-10 性别认同障碍代码。我们将进行叙述性访谈来学习 关于 TGD 退伍军人在大流行病爆发之前和之后的慢性疼痛护理经历。我们将 通过对采访记录进行主题分析来确定关键信息，特别关注未来的领域 护理优化。在目标 2 中，我们将应用 IDEAS 制作一部由专业演员扮演的 25 分钟电影 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人员分享该影片 在 1 小时的会议期间，TGD 资深小组成员参加了由 PI 主持的 15 分钟的片后会议 小组对话。利益相关者和提供商将完成接受前/后接受和行动调查问卷 – 耻辱，提供综合分数，较低的分数表明所制定的耻辱减少。一个 未调整的两个样本配对 t 检验将用于评估匹配前后 AAQ-S 调查的差异 分数。评估 IDEAS 是否可行且可接受地共享定性数据以促进可操作 变更时，我们将分发干预措施的可接受性（AIM）和干预的可行性 通过在线调查匿名测量（FIM），其中包括每个问题的开放式答复空间 项目，要求受访者描述 IDEAS 是否/如何促进可行的变革。我们将使用解释性的 顺序混合方法通过定性反馈扩展定量 AIM/FIM 结果。 后续步骤/实施：拟议的工作将产生一部描述慢性疼痛护理的 IDEAS 电影 TGD 退伍军人的经验可以由 CIPHER 利益相关者传播，以及前/后数据 提供商耻辱感和利益相关者对 IDEAS 可行性和可接受性的看法发生变化。