Justice and equity in pragmatic clinical trials: Considerations for pain research within integrated health systems

Learning Health Systems

Daniel I. Rhon¹  Joseph Ali²  Robert D. Kerns³  Alison F. Davis⁴  Sean Green⁴  Robert Vining⁵  Stacey Young‐McCaughan⁶  Diana J. Burgess⁷ 

[1] Brooke Army Medical Center and Uniformed Services University of the Health Sciences Fort Sam Houston Texas USA;Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA;Departments of Psychiatry, Neurology, and Psychology Yale University New Haven Connecticut USA;Pain Management Collaboratory, Department of Psychiatry Yale University School of Medicine New Haven Connecticut USA;Palmer Center for Chiropractic Research, Palmer College of Chiropractic Davenport Iowa USA;The University of Texas Health Science Center Houston Texas USA;VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center Minneapolis Minnesota USA;

关键词: equity;    ethics;    justice;    pain management;    pragmatic clinical trial;   

DOI  :  10.1002/lrh2.10291

来源: DOAJ

【 摘 要 】

Abstract Introduction Pragmatic clinical trials (PCTs) can overcome implementation challenges for bringing evidence‐based therapies to people living with pain and co‐occurring conditions, providing actionable information for patients, providers, health systems, and policy makers. All studies, including those conducted within health systems that have a history of advancing equitable care, should make efforts to address justice and equity. Methods Drawing from collective experience within pragmatic pain clinical trials networks, and synthesizing relevant literature, our multidisciplinary working group examined challenges related to integrating justice and equity into pragmatic pain management research conducted in large, integrated health systems. Our analysis draws from military and veteran health system contexts but offers strategies to consider throughout the lifecycle of pragmatic research more widely. Results We found that PCTs present a unique opportunity to address major influences on health inequities by occupying a space between research, healthcare delivery, and the complexities of everyday life. We highlight key challenges that require attention to support complementary advancement of justice and equity via pragmatic research, offering several strategies that can be pursued. Conclusions Efforts are needed to engage diverse stakeholders broadly and creatively in PCTs, such as through dedicated health equity working groups and other collaborative relationships with stakeholders, to support robust and inclusive approaches to research design and implementation across study settings. These considerations, while essential to pain management research, offer important opportunities toward achieving more equitable healthcare and health systems to benefit people living with pain and co‐occurring conditions.

【 授权许可】

Unknown