Background & Aims
Black people are disproportionately impacted by pain and have increased risk for poor pain care. This leads to Black patients exhibiting lower levels of patient activation (having knowledge, confidence, and skills to manage one’s health) and communication self-efficacy (one’s perceived ability to interact with providers). Consequently, Black patients are less likely to participate in shared decision making, where patients and providers work collaboratively to make decisions aligned with patients’ values and lived experiences. We developed GET PrEPD (Goal Elicitation, Treatment Prioritization, & Electronically-Practiced Discussion) to foster patient activation and communication self-efficacy among Black patients with chronic pain. In this pilot trial, we assessed the feasibility and acceptability of GET PrEPD (Aim 1) and its preliminary efficacy on patient activation, communication self-efficacy (primary outcomes), and pain intensity and interference (secondary outcomes) (Aim 2).
Methods
Black adults with chronic pain (>3 months) and internet access were recruited from a multidisciplinary pain clinic. GET PrEPD includes two parts: (1) Coaching involved 4 weekly, videoconference sessions with a coach to help patients clarify and prioritize treatment goals within their life context (patient activation) and to develop communication skills for the clinical setting (communication self-efficacy). (2) Online skills practice with 3D animated Virtual Providers allowed patients to further articulate their goals and priorities and to practice their communication skills. Descriptive statistics examined feasibility (retention) and acceptability (usability, expectation, satisfaction). Paired t-tests examined pre-post changes in patient activation (Consumer Health Activation Index), communication self-efficacy (Perceived Efficacy in Patient-Physician Interactions), and pain (Brief Pain Inventory). In this pilot study, we prioritized effect sizes over p-values.
Results
Sixteen patients enrolled and 15 completed the study. The majority were middle aged (M=53 yrs) women (13/16) with some college education (13/16). Patients rated the online practice system as highly usable, agreeing or strongly agreeing that: most people could learn to use it quickly; it was easy to use; they felt confident using it; and they would use it frequently. Patients reported pre-post increases in expectations about communicating treatment goals (d=.51, medium effect), discussing pros/cons of treatments (d=.26, small effect), and asking questions about treatments (d=.47, medium effect) at their next clinical visit. Patients were highly satisfied, rating the GET PrEPD session topics, coach, and online practice as “extremely” or “quite a bit” helpful. Patient activation (d=.51, medium effect) and communication self-efficacy (d=.28, small effect) increased; pain intensity (d=.10, small effect) and interference (d=.67, medium-large effect) decreased from pre- to post-intervention.
Conclusions
This pilot trial supports the feasibility and acceptability of an innovative patient-centered intervention to enhance patient activation and communication self-efficacy among Black patients with chronic pain. The individual coaching sessions and online practice with a Virtual Provider were well-received by patients. Moreover, this pilot trial provides preliminary evidence that GET PrEPD produces clinically meaningful improvements in patient activation, communication self-efficacy, and pain interference. As such, GET PrEPD is a promising intervention that complements other multi-level efforts to increase health equity and improve pain care for Black patients. The next step is to further build on these results with a multimethod randomized controlled trial to rigorously test this promising intervention.
References
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Presenting Author
Kristina M. Bogdan
Poster Authors
Kristina Bogdan
MSc
Indiana University-Indianapolis
Lead Author
Phil Procento
MS
Indiana University-Indiana
Lead Author
Alexis D. Grant
MA
Indiana University-Indiana
Lead Author
Megan M. Miller
PhD
Cincinnati Children's Hospital
Lead Author
Dmitry Arbuck
MD
Indiana Polyclinic
Lead Author
Marianne S. Matthias
PhD
Indiana University School of Medicine
Lead Author
Topics
- Racial/Ethnic/Economic Differences/Disparities