September 28, 2023

COOPERATE: Empowering minoritized patients with chronic back and other musculoskeletal pain to receive the care they need

photo of Marianne Matthias with pulled quote from press release

Tools facilitate health equity, autonomy, control over individual’s own healthcare

A new study led by a U.S. Department of Veterans Affairs, Regenstrief Institute and Indiana University School of Medicine researcher focuses on empowering minoritized patients with chronic back and other musculoskeletal pain to receive care best suited to their individual values and preferences. Black patients continue to experience greater pain severity, worse pain outcomes and inadequate pain treatment compared to White patients, despite national priorities focused on health equity.

COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) is one of the first studies to test and evaluate equipping Black adults who have chronic pain with tools to facilitate autonomy and control over their own care. Through six telephonic coaching sessions over 12 weeks, the randomized controlled trial provided 125 Black veterans with tools focused on increasing knowledge and confidence to self-manage their pain and on optimizing communication of their needs, preferences and desires to their physicians. An additional 125 Black veterans participated in the study’s control group and did not receive coaching. Average age of participants in both arms of the study was 61 years, and 83 percent were male.

The researchers found that the coaching produced significant improvement in patient activation (having the knowledge and confidence to manage their health and healthcare), which has been linked in other research to better treatment adherence, more positive experiences with healthcare, and better quality of life. In addition, patients who received the coaching experienced increased confidence in expressing themselves and communicating their pain-related goals to their clinicians. This improvement remained or improved after coaching ended.

Lower patient activation is associated with negative health outcomes, including depression and anxiety, as well as with poorer physical health. Poor patient-clinician communication is a known barrier to high-quality care.

“COOPERATE is focused on Black individuals with chronic pain. There are racialized disparities in chronic pain treatment at both the individual and system levels,” said Regenstrief, VA and IU School of Medicine researcher Marianne Matthias, PhD, who led the study. “Increasing patient activation is a novel way to improve pain self-management, and it’s an understudied path toward improving health equity and ultimately achieving the best possible care for each patient.”

COOPERATE coaches helped individuals think about how their pain management goals fit into their larger life goals, such as being more active with their children or grandchildren or participating in a physical activity. The coaches also focused on making communication with clinicians as clear and effective as possible by practicing techniques such as agenda setting to help patients get the most out of their medical appointments.

“Pain improved in the short term after coaching ended, which is interesting because coaching focused on patient activation and communication — not specifically on pain itself. And we were pleased to see an improvement in depression and anxiety, which actually worsened over time for those in the control group who didn’t receive coaching,” said Dr. Matthias. “COOPERATE coaching participants gained confidence in talking with their clinicians, including explaining their concerns and preferences, ultimately giving them more control of their chronic pain care. It clearly made a difference.”

The COOPERATE study was conducted at the Richard L. Roudebush VA Medical Center. The researchers hope to expand the study to multiple sites in the future.

Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): A Randomized Clinical Trial” is published in the peer-reviewed journal Pain.

Authors and affiliations:
Marianne S. Matthias, PhD.1,2,3; Joanne K. Daggy, PhD.4; Anthony J. Perkins, M.S.4; Jasma Adams, M.P.H.1; Matthew J. Bair, M.D., M.S.1,2,3; Diana J. Burgess, PhD.5,6; Johanne Eliacin, PhD.1,2,7; Perla Flores, B.S.1; Laura J. Myers, PhD.1,2,3; Tetla Menen1; Philip Procento, M.S.8; Kevin L. Rand, PhD.8; Michelle P. Salyers, PhD.8; Mackenzie L. Shanahan, Ph.D.9; and Adam T. Hirsh, PhD.8

1VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN
2Regenstrief Institute, Indianapolis, IN
3Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
4 Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
5Department of Medicine, University of Minnesota, Minneapolis, MN
6 Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN
7National Center for PTSD, VA Boston Healthcare System, Boston, MA
8Department of Psychology, Indiana University-Purdue University, Indianapolis, IN
9 VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

This work was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review Award to Dr. Matthias (IIR 17-032).

Marianne S. Matthias, PhD
In addition to her role as a research scientist at Regenstrief Institute, Marianne S. Matthias, PhD, is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis. She is also a senior research professor of medicine at Indiana University School of Medicine.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About Veteran Health Indiana and CHIC
The Richard L. Roudebush VA Medical Center is the flagship medical center for Veteran Health Indiana, the VA’s healthcare system in central and southern Indiana. The medical center is located in downtown Indianapolis, and is collocated with three large community hospitals and the campus of the Indiana University Schools of Medicine and Nursing. The health system has been serving Hoosier Veterans since 1932. As Indiana’s Level 1a, tertiary care Veteran facility, the medical center serves as home base for a system of inpatient and outpatient care locations serving more than 62,000 Veterans.

The VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) group is a diverse cadre of researchers based at Roudebush VA Medical Center who work together to transform the healthcare system, both within and outside the VA so every patient receives consistent, high-quality care.

About IU School of Medicine 
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

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