HSR&D Research Career Scientist Award

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My research focuses on understanding and improving chronic pain management for Veterans by leveraging my expertise in health communication, patient engagement, and relationship-centered care. Over the past 14 years, my work has developed from observational to interventional, steadily increasing the impact of my scholarship on Veterans’ care. My research has helped to advance our understanding of how communication shapes healthcare experiences and Veterans’ pain management. Early observational work led to insights into the role of the patient-provider relationship and social support in pain self-management, treatment decision- making, and opioid management, including opioid tapering. I have successfully built upon these findings with each new project, which has led to the design and testing of interventions to improve pain management for Veterans. These interventions have included developing and testing a peer-supported pain self-management program, a coaching program designed to increase patient activation for Black Veterans with chronic pain to help address racialized disparities in pain management, and a shared decision-making intervention to overcome patient-level barriers to use of and adherence to evidence-based nonpharmacologic pain treatments. Beyond developing and testing interventions, I am also moving toward implementation in an effort to broaden my impact and improve care for Veterans. My health equity study, COOPERATE, significantly increased patient activation and communication self-efficacy, while producing other positive outcomes for Black Veterans. In light of these positive results I will be exploring avenues for implementation through our operational partners as well as likely submitting a proposal for a Hybrid Type 2 multi-site effectiveness/implementation study, to further test COOPERATE and prepare for system-wide implementation. COOPERATE represents an important path to achieving health equity for Black Veterans with chronic pain and as such, also represents the increasing impact of my research. My newly-funded study, OPTIONS, also has direct relevance for Veteran care and impact. OPTIONS reflects VA’s priorities of reducing reliance on opioids and increasing use of multimodal care, including evidence-based complementary and integrative therapies and other nonpharmacologic approaches to chronic pain. As such, I have partnered with the VA National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program Office and the Office of Patient- Centered Care and Cultural Transformation, and, assuming positive results, these partnerships will help increase the project’s impact by facilitating VA-wide dissemination and, ultimately, implementation. These examples reflect the evolution of my work from early observational studies to intervention studies, which will ultimately lead to system-wide implementation and greater impact on Veterans’ pain care. The other study I am currently leading as co-PI, CIPHER, is focused on understanding effects of COVID-19-related disruptions in pain care on Veterans with chronic low-back pain, with particular emphasis on disruptions to nonpharmacologic care, which can be more difficult to deliver via telehealth. Using a mixed-methods design with VA administrative data and qualitative interviews with clinicians and Veterans purposefully sampled from the administrative data, we are partnering with the VA National Pain Management Office to understand changes in care and, ultimately, apply these lessons to improving pain care for Veterans.