Communication and activation in pain to enhance relationships and treat pain with equity (COOPERATE): a randomized clinical trial

Abstract

Racialized disparities in chronic pain care are well-documented and persist despite national priorities focused on health equity. Similar disparities have been observed in patient activation (ie, having the knowledge, confidence, and skills to manage one's health). As such, interventions targeting patient activation represent a novel approach to addressing and reducing disparities in pain care. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity is a randomized controlled trial of a 6-session telephone-delivered intervention to increase patient activation for Black patients with chronic pain. Two hundred fifty Black patients from a Midwestern Veterans Affairs medical center were randomized to the intervention or attention control. The primary outcome was patient activation; secondary outcomes included communication self-efficacy, pain, and psychological functioning. Outcomes were assessed at baseline and at 3 (primary endpoint), 6, and 9 months (sustained effects). Analyses used an intent-to-treat approach. Compared with baseline, patient activation increased 4.6 points at 3 months (versus +0.13 in control group, 95% CI: 0.48, 7.34; P = 0.03). These improvements in the intervention group were sustained, with +7 from baseline at 6 months and +5.77 at 9 months, and remained statistically significant from the control group. Communication self-efficacy increased significantly relative to the control group from baseline to 3 months. Pain intensity and interference improved at 3 months, but differences were not significant after adjusting for multiple comparisons. Most other secondary outcomes improved, but group differences were not statistically significant after controlling for multiple comparisons. Results suggest that increasing patient activation is a potentially fruitful path toward improving pain management and achieving health equity.

Improving the art and science of communication in people living with chronic pain

“…The randomized clinical trial COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) study authored by Matthias et al 11 addresses the role of enhanced communication with patients to improve health outcomes and health equity. Specifically, it adds to our knowledge on the effectiveness of multimessaging communication as a modality to promote patient activation in Black veterans and as a mechanism to enhance pain management in this population.…”

“…However, the results presented by Mathias et al 11 need to be carefully interpreted, and several issues clarified to determine the usefulness of enhanced phone messaging. Of particular, import is considering why the benefits of multimessaging were not sustained in reducing pain intensity and communication self-efficacy.…”