Engagement Panels Bring Veterans' Perspectives to Pain/Opioid AMP Research Priorities

Veterans’ Perspectives highlights research conducted by HSR and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the March-April 2024 Issue:

• Introduction: The new Pain and Opioid AMP sought help from HSR Veteran Engagement Panels and QUERI to set research priorities.
• Research Priority-Setting Process: An adapted clinical process kept stakeholders focused.
• Veteran Impact: VE Panels utilized multiple iterations to confirm priorities.
• Making a Difference: Both panel members and investigators recognized the value of the collaborative approach.
• Next Steps: QUERI's CEIR is working with the VA Office of Enterprise Integration to expand the use of this model.

Introduction

VA has the largest integrated learning health care system in the U.S. and funds research focused on health issues that affect Veterans. Increasingly, VA research leadership has sought to include Veterans in all steps of the health research translation path from the laboratory to health care and policy.

In 2023, the Pain and Opioid Use Actively Managed Portfolio (AMP) of research was launched by the Office of Research and Development (ORD) as part of an organizational shift to better identify and respond to critical research priorities related to pain and opioid use – and the consequences of opioid use. To make the best use of research dollars, Pain and Opioid Use AMP and ORD leaders engaged in a rigorous priority-setting process that intentionally integrated the perspectives of Veterans who have experienced chronic pain, prescribed opioid treatment for pain, and/or opioid use disorder. Veterans and staff from the Pain/Opioid Consortium of Research (CORE) Veteran Engagement (VE) Panel worked with a team from QUERI to facilitate Veteran involvement in determining research priorities for the new Pain and Opioid Use AMP.

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Research Priority-Setting Process

The QUERI team adapted a resource implementation and evaluation model that had proven successful in VA medical centers,¹ and worked with Pain and Opioid Use AMP leaders to:

• Generate an initial list of priorities: The team summarized existing knowledge and perspectives about key unanswered questions in pain/opioid research gathered from reports, strategic plans, and VA and non-VA reviews of current research.
• Refine the list of research priorities: Stakeholders – including Veterans, researchers, policymakers, and providers representing nursing, pain management, mental health/substance use disorder, neurology, pharmacy, and rehabilitation – refined priorities through focus groups and surveys.
• Rank the priorities using a group process: The team hosted rounds of discussion and voting with representatives from different stakeholder groups; the following factors were the criteria for ranking:
  1. Urgency
  2. Impact of filling the research gap
  3. Feasibility of carrying out the research
• Submit priorities to the VA Research Executive Committee: The final list was used in a new opportunity for VA researchers to apply for funding in Fall 2023. Researchers were advised to focus their proposed studies on one or more research priorities on the final list.

Figure: Research Priority-Setting Process for the Pain/Opioid AMP

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Veteran Impact

Veterans played a crucial role during the second phase of the priority setting process by providing instrumental feedback on the initial list of pain/opioid research priorities. Pain/Opioid CORE engagement staff collaborated with the QUERI team to design a VE Panel meeting including a facilitation guide and background materials for panel members consisting of a project overview and a version of the initial research priorities translated into plain language. In addition to arranging to meet with the Pain/Opioid CORE VE Panel, CORE staff collaborated with engagement colleagues to facilitate visits with two other VE panels whose members have lived experience relevant to pain or opioids: the Substance Addiction and Recovery Veteran Engagement Board based at the VA Eastern Colorado Health Care System, and a special meeting of members from various panels hosted by the Center for Care Delivery and Outcomes Research (CCDOR) at the Minneapolis VA Health Care System.

VE panel members reviewed meeting materials, including the plain-language list of research priorities and background information, ahead of their respective meetings. At each of the VE panel meetings, facilitators reviewed the priority-setting process and initial list of pain/opioid research priorities. Next, VE panel members voted on their top three priority areas. Following this initial vote, several breakout sessions revealed details about members’ perspectives and identified topics members believed were missing from the initial list. A follow-up vote was then held, when panel members could select the same or a new set of top-three research priorities.

Pain/Opioid CORE engagement staff (top left and top middle) and members of the CORE’s Veteran Engagement Panel.

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Making a Difference

Veterans directly influenced the priorities recommended by the VA Research Executive Committee, especially those related to:

• Studies identifying new therapeutic targets for pain, tolerance, and/or opioid use disorder.
• Clinical treatments for long-term recovery from pain, especially non-opioid treatments.
• Environmental, social, and policy changes addressing social determinants to prevent opioid misuse (including policies related to telehealth/virtual care, Veterans benefits, and jail diversion programs).
• Implementation of treatments and approaches to enhance pain treatment services, especially for underserved groups.
• Research on the risk factors, treatment, and prevention of opioid use disorders.

VE panel members recognized the importance of their involvement and appreciated the opportunity to discuss and influence VA research priorities:

“I appreciate that we were given the opportunity be a part of priority setting.”

“It’s fun to be able to provide guidance at the beginning of a funding call for the researchers.”

“It was good to reevaluate after I’d had a chance to discuss the priorities.”

-VE panel members

Additionally, researchers gained a new appreciation for inclusion of Veterans in research priority setting:

“The input definitely gave us a sense of some of the challenges in a way that reading a paper about those same challenges doesn't do. We heard directly from Veterans and this really bolsters the credibility for centering those concerns” – VA QUERI Team Member

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Next Steps

VA research leaders were pleased with the development and outcomes of the priority-setting process and recommended its use for other research areas going forward. HSR-based Veteran engagement panels and staff will continue to help promote and facilitate Veteran-centered research across VA. QUERI’s Center for Evaluation and Implementation Resources (CEIR) is working closely with the VA Office of Enterprise Integration to use the priority-setting framework, including extensive Veteran engagement through the many HSR standing VE panels, to contribute to VA’s next strategic plan.

References:

Braganza MZ, Pearson E, Kilbourne AM, et al. Aligning Quality Improvement Efforts and Policy Goals in a National Integrated Health System. Health Services Research. June 2022;57(S1):9–19. Epub March 4, 2022.

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