Objectives: The overall objective of our mixed method study is to evaluate a strategy to improve the quality and clinical usefulness of 'the 5th Vital Sign' in VA primary care. We will formatively evaluate experiences with and implementation of the enhanced pain screening approaches (patient self administered computer aided) including clinician perspectives on the use of pain screening to guide management.
Our specific aims are to:
Aim 1. Characterize primary care team perspectives on enhanced pain screening approaches compared with usual pain screening re., clinical usefulness and how to use skills, roles, and tasks of multidisciplinary clinicians and consultants to optimize pain care. Interviews will inform development of the screening interface we will evaluate the interface including the PEG and 'NRS now' in a human-computer interaction laboratory.
Aim 2. Evaluate in a three-arm RCT the effects of enhanced pain screening approaches using the PEG (Arm 1), the 'NRS pain now' (Arm 2), compared with usual clinician-assessed pain screening (Arm 3), on (Aim 2a) the detection of patient pain at one week and (Aim 2b) feasibility, acceptability, and experiences with (e.g., pain missingness, bystander completion rates, patient and staff experiences and satisfaction) patient-reported computer-aided pain assessment using quantitative patient screening outcomes, an d interviews with patients, clinic and facility staff Research Plan: At three sites (VA GLA, Indianapolis, and Portland) we will conduct interviews with primary care staff about their experiences with pain screening and how to link screening to management in order to inform development of an integrated enhanced pain screening approach (using PEG and NRS now) on a touchscreen together with survey questions on Veteran demographics, co-morbidity, and risk for under-assessed pain. The integrated protocol will be installed on a touchscreen kiosk to use in a 3 arm RCT to evaluate the optimal approach to pain screening, along with an evaluation of the implementation experience. Methodology: Clinicians, clinic staff, and facility staff will be interviewed and multidisciplinary focus groups conducted at 3 sites to characterize the range of themes related to staff perspectives on patient reported versus clinician documented pain. Development of the enhanced pain screening protocol will account for clinician perspectives informed by qualitative input, as well as usability testing, and then subjected to an RCT after being integrated into a kiosk that will be placed in primary care for every Veteran to complete before nursing staff administered pain screening. Veterans will be randomly allocated in a 1:1:1 ratio to the three arms and analyses will evaluate a variety of quantitative and qualitative outcomes. Experience during the trial will inform implementation and be gathered through interviews with both patients and providers and clinic staff. Results: This is a new project and results have not yet been obtained. Significance: We will characterize how to best conduct pain screening including a direct comparison of patient reported (e.g., PRO) to clinician documented pain, and selection of an optimal measure to improve clinician and patient centeredness of pain measurement (e.g., by considering the incorporation of function). This project will inform national VA implementation of a preferred measure and method.
Pain is one of the most common and debilitating problems that Veterans of all ages face. This project will improve the Veteran-centeredness of pain screening by incorporating function. It will inform how to best incorporate a range of other Veteran-centered subjective concerns in the health record and care experience to guide improved management (e.g., other symptoms). It will provide an evaluation of a highly scalable, efficient strategy for improving the assessment and documentation of pain (currently missing from many important specialty settings), and provide insight into an implementation strategy to guide that dissemination.
