Equity Using Interventions for Pain and Depression (EQUIPD)

项目摘要 非药物性疼痛治疗（NPTs）得到了证据的支持，并被广泛推荐用于治疗 指南然而，这些方法仍然没有得到充分利用。即使随着访问的增加，一些与患者有关的 障碍依然存在，包括缺乏对《不扩散核武器条约》可用性和有效性的了解， 沟通，以及参与和遵守方面的挑战-特别重要，因为NPT通常 需要更多的承诺，时间和努力，而不是服用药物。这些障碍可能特别 对于患有共病抑郁症的患者来说尤其明显，因为抑郁症状会干扰疼痛 管理，以及黑人患者，他们继续经历疼痛治疗的差异，包括 提供的治疗选择比白色患者少。本提案的总体目标是完善、测试和 准备实施一种新的方法，以克服与患者有关的使用NPT的障碍， 患有疼痛和抑郁症的黑人患者。公平使用疼痛干预措施， 抑郁症）使用1）侧重于NPT的决策辅助工具来增加使用，以及2）教练来培养患者 参与和治疗依从性。借鉴种族歧视多层次机制的启发式模型， 在痛苦的结果不公正，BHD开始关注个人，同时奠定基础， 结构层面的干预（即，诊所/医疗保健系统），随后在全系统范围内 实施.在第一阶段，我们将建立一个患者参与小组， 对决策辅助的观点，并进行了一项2臂试点随机对照试验（RCT）， 干预以测试和完善程序。在第2阶段，我们将进行一项全把握度（N=250）RCT， 评价全系统执行工作的促进因素和障碍。主要结局是疼痛 干预（6个月时）;次要结局包括抑郁、NPT使用、焦虑、疼痛灾难化， 和患者参与度。为方便实施计划，我们会有目的地与 干预患者的抽样子集，并与临床医生，管理员和其他诊所工作人员，以优化 并阐明全系统执行的关键因素。同时， 疼痛治疗中普遍存在的差异以及与共病疼痛和抑郁症相关的挑战， 与少数群体患者合作，并使他们能够找到安全、有效的慢性疼痛治疗方法， 他们的价值观、偏好和生活方式。此外，通过以下方式， 促进多模式的疼痛护理方法，适合个别患者的需要。

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.