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2023 HSR&D/QUERI National Conference Abstract

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4017 — Addressing Barriers to Pain Self-Management in Women Veterans: A Feasibility Pilot of Project CONNECT

Lead/Presenter: Mary Driscoll,  COIN - West Haven
All Authors: Driscoll MA (VA Connecticut, Yale School of Medicine), Selander, K (VA Connecticut) Kerns, RD (VA Connecticut, Yale School of Medicine) Haskell, SG (VA Connecticut, Yale School of Medicine) Heapy, AA (VA Connecticut, Yale School of Medicine)

Objectives:
Objective: Women are the fastest-growing segment of Veterans Healthcare Administration (VA) utilizers and rates of pain are high. VA has placed considerable emphasis on promoting pain self-management. Despite having a widely supported program for doing so, cognitive behavioral therapy for chronic pain (CBT-CP), several barriers (e.g., logistical, healthcare delivery, and psychosocial) to accessing and engaging optimally with it may be salient for women. Efforts to address these barriers may translate to improved treatment access, engagement, adherence, and improved outcomes. Accordingly, a home-based intervention integrating an evidence-based CBT-CP program with reciprocal peer support (RPS) has been developed (CONNECT) and a non-randomized feasibility/acceptability pilot conducted.

Methods:
Four hundred twenty-two potentially eligible women were sent opt-out letters between May 2019 and January 2021 inviting participation. Those who did not opt-out were called and screened for eligibility. Women with two or more chronic (ICD-10) back pain visits within one year, who endorsed past week pain interference > 4 using a numerical reporting scale, and who were psychiatrically stable were eligible. Enrolled participants were paired, given a pain self-management handbook and a pedometer. Dyads independently worked through 12 CBT-CP modules at a pace of one per/week and participated in a graduated walking program; they texted each other nightly and participated in one weekly telephone call to encourage adherence, provide support and set activity goals. Feasibility and acceptability metrics included recruitment and retention rates, treatment satisfaction and qualitative interviews. A responder analysis captured the percent of participants reporting clinically meaningful improvements in pain interference and disability.

Results:
Of those sent letters, 28% were unable to be reached by phone, 34% were uninterested, 24% were ineligible upon further screening and 13% (n = 54) were eligible. A total of 22 were interested, consented, enrolled, and paired - yielding a recruitment rate of 1.05/month. On average, women who enrolled were 51.14(SD 13.82) years old. Sixty-eight percent were white, 50% were partnered. Pain was moderate (M = 6.30,SD = 1.58). Participants averaged a mean of 11.0(SD = 2.35) weeks of treatment and interacted with their peer partner for an average of 7.9(SD = 4.1) weeks; only one participant was lost to follow-up. Most (94%) reported being at least moderately satisfied with CONNECT. Approximately 41% reported clinically meaningful improvements (30% reduction) in pain interference and disability. Qualitative feedback revealed that CONNECT “gave me permission to meet my own needs rather than everyone else’s” and it provided an “opportunity to help someone else, while helping myself.” Suggestions for improvements included more interaction with staff “to reinforce changes and clarify questions,” more optimal peer matching and mitigation if a peer prematurely disengaged.

Implications:
Though CONNECT was acceptable to those who enrolled and yielded clinically meaningful benefit for many, interactions with peer partners were variable and the recruitment rate was not optimal. A refined trial using an opt-in recruitment strategy, periodic clinician coaching, and matching based on age/functional status is currently underway.

Impacts:
Reciprocal peer support pain self-management interventions for women hold promise, but require enhancements to optimize engagement and benefit.