Equity Using Interventions for Pain and Depression (EQUIPD)

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Project Summary Nonpharmacological pain treatments (NPTs) are supported by evidence and widely recommended in treatment guidelines. However, these approaches remain underused. Even as access increases, several patient-related barriers remain, including lack of knowledge about NPT availability and effectiveness, poor patient-provider communication, and challenges to engagement and adherence –particularly important as NPTs typically require more commitment, time, and effort than taking medications. These barriers may be especially pronounced for patients with comorbid depression, since depressive symptoms can interfere with pain management, and for Black patients, who continue to experience disparities in pain treatment, including being offered fewer treatment options than White patients. The overall goal of this proposal is to refine, test, and prepare to implement a novel approach to overcoming patient-related barriers to NPT use that is tailored to Black patients with comorbid pain and depression. EQUIPD (Equity Using Interventions for Pain and Depression) uses 1) a decision aid focused on NPTs to increase use, and 2) a coach to foster patient engagement and treatment adherence. Drawing on a heuristic model of multi-level mechanisms of racial injustice in pain outcomes, EQUIPD begins by focusing on the individual, while laying the groundwork for later intervention at the structural level (i.e., clinic/healthcare system) through subsequent system-wide implementation. In Phase 1, we will establish a patient engagement panel, elicit primary care providers’ perspectives on the decision aid, and conduct a 2-arm pilot randomized controlled trial (RCT) of the intervention to test and refine procedures. In Phase 2 we will conduct a fully powered (N=250) RCT and evaluate facilitators and barriers to system-wide implementation. The primary outcome of EQUIPD is pain interference (at 6 months); secondary outcomes include depression, NPT use, anxiety, pain catastrophizing, and patient engagement. To facilitate implementation planning, we will conduct interviews with a purposefully sampled subset of intervention patients and with clinicians, administrators, and other clinic staff to optimize the intervention and elucidate critical factors for system-wide implementation. EQUIPD simultaneously addresses disparities pervasive in pain treatment and challenges related to comorbid pain and depression, by partnering with and empowering minoritized patients to find safe, effective approaches to chronic pain that best match their values, preferences, and lifestyles. Moreover, EQUIPD helps to advance the National Pain Strategy by promoting multi-modal approaches to pain care that is tailored to individual patients’ needs.