Addressing the “Readiness Gap:” An eHealth Intervention to Increase Patient Motivation for Evidence-Based Chronic Pain Interventions and Reduced Opioid Reliance

解决“准备差距”：电子健康干预措施可提高患者对循证慢性疼痛干预措施的积极性并减少阿片类药物的依赖

• 批准号: 10724026
• 负责人: Taylor Berens Crouch
• 金额: $ 16.87万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10724026
• 关键词: 3-Dimensional; Addictive Behavior; Address; Adherence; Adult; American; Area; Behavior Therapy; Behavioral; Clinical; Clinical Medicine; Clinical Trials; Cognitive Therapy; Complex; Computer software; Control Groups; Country; Crutches; Dependence; Development; Diabetes Mellitus; Doctor of Philosophy; Education; Enabling Factors; Epidemic; Evidence based intervention; Evidence based treatment; Focus Groups; General Practitioners; Goals; Health; Health behavior; Improve Access; Individual; Intervention; Interview; Life; Medical Research; Mentors; Motivation; Opioid; Outcome; Output; Overdose; Pain; Pain management; Patient Self-Report; Patients; Pharmaceutical Preparations; Physical therapy; Populations at Risk; Positioning Attribute; Process; Provider; Psychologist; Quality of life; Readiness; Records; Research; Research Personnel; Risk; Risk Behaviors; Sampling; Science; Self Efficacy; Self Management; Structure; System; Testing; Training; Twin Multiple Birth; acceptability and feasibility; addiction; barrier to care; behavior change; career; chronic pain; chronic pain management; chronic pain patient; computer human interaction; computerized; contextual factors; contingency management; eHealth; effective therapy; evidence base; follow-up; implementation science; improved; innovation; interest; medical specialties; motivational enhancement therapy; non-opioid analgesic; novel vaccines; nutrition; opioid epidemic; opioid overdose; opioid tapering; opioid therapy; opioid use; opioid use disorder; pain behavior; patient oriented; patient response; pilot trial; prescription opioid; prevent; programs; prototype; randomized, clinical trials; recruit; satisfaction; systemic barrier; theories; treatment center; uptake; usability; virtual

PROJECT SUMMARY / ABSTRACT The overarching goal of this 5-year K23 proposal is to support Taylor Crouch, PhD, in her development as an independent investigator in the overlapping areas of chronic pain and addiction, with a focus on enhancing uptake of evidence-based nonpharmacological chronic pain interventions and reducing reliance on long term opioid therapy (LTOT). Evidence-based behavioral interventions for pain are among the most effective and safe treatments, but utilization remains low, especially among patients on LTOT. The risks of LTOT, including opioid use disorder and overdoses, are well-established, but complex dependence can limit patients’ readiness to try something different. Two key barriers to uptake of nonpharmacological interventions have been identified as low motivation and logistical barriers to care. Two existing evidence-based interventions to enhance motivation and support behavior change, Motivational Interviewing (MI) and Contingency Management (CM), have promise for enhancing readiness to change among patients with chronic pain displaying risks on LTOT, and eHealth interventions can improve access and reach of interventions. Therefore, the objective of this proposal is to develop a MI/CM eHealth intervention to increase readiness to utilize nonpharmacological treatments and reduce reliance on opioids among individuals displaying risk on LTOT. Specific Aims are: Aim 1: To inform intervention approach, conduct exploratory testing with providers and patients to clarify needs/barriers, consolidate existing theory/evidence using the Medical Research Council framework, and complete initial testing of intervention ingredients. Aim 2: Develop an alpha prototype MI/CM eHealth intervention aimed at enhancing motivation to utilize nonpharmacological treatments and reduce opioid reliance, using the Computerized Intervention Authoring System, and assess usability. Aim 3: Develop beta and conduct a pilot randomized clinical trial to assess feasibility and acceptability. At the completion of the pilot trial in Aim 3, the intervention will be ready to be tested in an R01 to evaluate its efficacy in enhancing not only motivation, but action toward reduced opioid use and utilization of evidence- based non-opioid CP interventions. This proposal represents a 5-year comprehensive mentoring, training, and research plan to transition the candidate, Dr. Crouch, to a career as a successful independent investigator. Dr. Crouch has background training and expertise in behavior change, motivation, addictive behaviors, and behavioral chronic pain interventions, and through her comprehensive training plan she will be positioned to become a leader in these areas and further develop her expertise in implementation science and clinical trials.

项目摘要/摘要 这项为期5年的K23计划的首要目标是支持泰勒·克劳奇博士在她的 作为慢性疼痛和慢性疼痛重叠领域的独立研究人员的发展 成瘾，重点是加强循证非药理学慢性疾病的接受 疼痛干预和减少对长期阿片类药物治疗的依赖。循证的 对疼痛的行为干预是最有效和最安全的治疗方法之一，但 使用率仍然很低，特别是在使用LTOT的患者中。LTOT的风险，包括阿片类药物 使用障碍和过量用药是公认的，但复杂的依赖会限制患者的 准备尝试一些不同的东西。吸收非药用药物的两个关键障碍 干预措施已被确定为缺乏动力和护理的后勤障碍。两个现有的 以证据为基础的干预措施，以增强动机并支持行为改变，激励 面谈(MI)和应急管理(CM)，有望增强对 慢性疼痛患者在LTOT上表现出风险的变化和电子健康干预 可以改善干预措施的可及性和可及性。因此，这项建议的目标是 开发MI/CM电子健康干预措施，以提高利用非药物疗法的准备程度 治疗和减少对长期服用阿片类药物有风险的个人的依赖。特定的 目标：目标1：告知干预方法，与供应商进行探索性测试 和患者澄清需求/障碍，整合现有理论/证据 研究理事会框架，并完成干预成分的初步测试。目标2： 开发旨在增强使用动机的阿尔法原型MI/CM电子健康干预 使用计算机化的非药物治疗和减少阿片类药物依赖 干预创作系统，并评估可用性。目标3：开发测试版并进行试验 随机临床试验，评估可行性和可接受性。在试点试验结束时 在目标3中，干预措施将准备在R01中进行测试，以评估其在 不仅增强动力，而且采取行动减少阿片类药物的使用和证据的利用- 基于非阿片类CP干预。这项提案代表着一项为期5年的全面 指导、培训和研究计划将候选人克劳奇博士转变为 成功的独立调查员。克劳奇博士有背景培训和专业知识 行为改变、动机、成瘾行为和行为慢性疼痛干预， 通过她的全面培训计划，她将成为这些领域的领导者 并进一步发展她在实施科学和临床试验方面的专业知识。