Implementing Integrated Whole-Person Care for Chronic Pain: Lessons from VA's Multisite wHOPE Study

Guidelines recommend multimodal, biopsychosocial care for chronic pain, but implementing this care on a large scale can be challenging. Recently, the Whole Health Options and Pain Education (wHOPE) study implemented and evaluated a Whole Health Team (WHT) intervention at six VA medical centers across the USA. WHT is an interdisciplinary team composed of a medical provider, a complementary and integrative health (CIH) provider, and a health coach who together provide holistic, non-pharmacological pain care. In a randomized controlled clinical trial of 764 VA patients with chronic pain, WHT was more effective than comparators (group cognitive behavioral therapy and usual care) in reducing pain interference and improving other pain-related outcomes. Given WHT's effectiveness, it is important to examine the feasibility of widespread WHT implementation.

Using qualitative methods, we examined barriers and facilitators to WHT implementation and factors affecting WHT sustainability.

Informed by the Practical Robust Implementation and Sustainability Model, we conducted semi-structured interviews with 43 clinicians and staff involved in wHOPE intervention implementation. We used template-based rapid analysis to identify interview themes.

Clinicians valued the WHT intervention and felt it enhanced their practice and improved patient care. Interviews highlighted key factors impacting WHT implementation and sustainability. Regarding team composition and collaboration, interviewees identified a need for consistent team membership, sufficient allocated clinician effort, clearly delineated clinician roles, and routine team huddles. Regarding organizational infrastructure and integration, interviewees identified a need to address existing gaps in pain care, collaborate closely with primary care, and establish referral pathways to complementary wellness and treatment modalities. Interviewees also emphasized the need for skilled administrative coordination to support implementation and ongoing operations.

Implementing holistic, person-centered, interdisciplinary pain care is complex and comes with unique challenges, but our qualitative investigation identified promising strategies to promote successful implementation and sustainability.