HSR&D Research Career Scientist Award

我的研究重点是了解和改善退伍军人的慢性疼痛管理， 我在健康沟通、患者参与和以关系为中心的护理方面的专业知识。过去14 多年来，我的工作已经从观察发展到干预，稳步增加我的影响， 退伍军人护理奖学金我的研究帮助我们更好地理解 塑造医疗保健经验和退伍军人的疼痛管理。早期的观察工作使我们了解到 患者-提供者关系和社会支持在疼痛自我管理，治疗决策中的作用- 制作和阿片类药物管理，包括阿片类药物逐渐减少。我已经成功地建立在这些发现与 每个新项目都导致了干预措施的设计和测试，以改善疼痛管理， 老兵这些干预措施包括开发和测试同伴支持的疼痛自我管理 计划，一个教练计划，旨在增加患者激活黑人退伍军人与慢性疼痛， 帮助解决疼痛管理中的种族差异，以及共同决策干预， 克服使用和坚持循证非药物性疼痛的患者层面障碍 治疗。除了开发和测试干预措施外，我还在努力实现 扩大我的影响力，改善对退伍军人的照顾。我的健康公平研究，合作，显着 增加患者的激活和沟通自我效能，同时产生其他积极的结果， 黑人退伍军人鉴于这些积极成果，我将探讨通过我们的 运营合作伙伴以及可能提交的混合型2多站点提案 有效性/执行情况研究，以进一步测试合作，并为全系统执行做好准备。 合作代表了实现慢性疼痛黑人退伍军人健康公平的重要途径， 同样也代表了我研究的影响力越来越大我新资助的研究，选项，也有 对退伍军人的关怀和影响。OPTIONS反映了VA减少对阿片类药物依赖的优先事项 以及越来越多地使用多模式护理，包括循证补充和综合疗法， 其他非药物治疗慢性疼痛的方法。因此，我与退伍军人管理局国家疼痛局合作， 管理，阿片类药物安全和处方药监测计划办公室和病人办公室- 中心护理和文化转型，而且，假设取得积极成果，这些伙伴关系将有助于 通过促进VA范围内的传播和最终的实施来增加项目的影响。这些 这些例子反映了我的工作从早期观察性研究到干预性研究的演变， 最终导致全系统的实施和对退伍军人疼痛护理的更大影响。另一项研究是 CIPHER目前作为共同PI领导，专注于了解COVID-19相关中断对 疼痛护理的退伍军人与慢性腰痛，特别强调中断非药物 通过远程保健提供的护理可能更加困难。使用VA的混合方法设计 行政数据和与临床医生和退伍军人的定性访谈， 管理数据，我们正在与VA国家疼痛管理办公室合作，以了解 护理，并最终将这些经验教训应用于改善退伍军人的疼痛护理。

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.