Engaging Clinicians in Patient-Centered Research

Making Research Easy for Clinicians

Two of these projects work with urban community health centers treating patients with chronic pain, many of whom are from minority groups and live in poverty. The investigators are testing acupuncture and other integrative treatment approaches to address pain. “Clinicians really want another tool in the toolkit,” says Diane McKee, MD, MS, of Albert Einstein College of Medicine in New York City. “They struggle to find ways to decrease pain and improve function.”

The project she leads is comparing group acupuncture—providing this treatment to multiple patients in a single room—with traditional one-on-one acupuncture.

Offering acupuncture to patients who wouldn’t otherwise have access to it was not a hard sell to the clinics’ doctors, McKee reflects. Trickier was squeezing the service into the bustling clinic.

“A day-to-day struggle is that these health centers have no space,” McKee says. Early in the study, the research team met with clinical staff to find evening and weekend times when conference rooms or other group settings would be available for acupuncture sessions.

The team also made it easy for clinicians to refer patients to the study. “They just identify patients with chronic pain and discuss with them whether they would be interested in acupuncture,” McKee says. “That’s it. We do everything else.”

The researchers and acupuncturists attend clinic meetings, keeping the clinicians up-to-date on what the research team is doing, and relating stories about how the patients are experiencing the acupuncture treatments.

Building Bridges

Another study, at Boston health centers, also seeks to bring integrative medicine to patients with chronic pain. This study is testing group medical visits—8 to 12 patients see a clinician at once—focusing on nonpharmacological techniques for relieving pain, such as acupressure, meditation, yoga, and massage.

“We first needed to build bridges with the community health centers,” reflects Paula Gardiner, MD, MPH, of Boston Medical Center. “In our community health centers, patients with chronic pain did not have options for non-opioid treatments,” she says. “They can’t afford an acupuncturist; they can’t afford yoga classes.” 

A family medicine physician herself, Gardiner well understood clinicians’ needs. Doctors were trying to handle complicated medical problems in quick visits, she notes. “I met with the clinics’ upper leadership and with the clinicians,” Gardiner says. “I said, Will you partner with me? Will you sit at the table with me to figure this out?”

The clinicians and a patient advisory group helped shape the integrated medical group visit, revising the curriculum and creating videos. “In the beginning, we had an intervention that was A, but when we ended the design, we were at Z,” Gardiner reflects. For instance, the doctors suggested that, to help them identify patients who might join the study, a research team member should attend every morning huddle of physicians and medical assistants at which they plan their daily schedule. 

“We changed our recruitment and workflow plans based on the workflow of the community health centers,” Gardiner says.

Although the project required time from busy clinicians, it is likely to benefit the clinics after the study is over. The doctors will be able to continue using their training in nonpharmacological techniques for managing pain. “This could be a long-term solution to help their chronic pain patients,” Gardiner says.

Coming Together in Town Halls

A project in Philadelphia is examining whether community health workers—trained laypeople who help patients address the social determinants of health as a means to achieving health goals—can improve outcomes for people with chronic diseases. (See related article, Between Clinicians and Patients, Trained Community Members May Provide a Key Link.) The research team’s idea for better engaging clinicians grew out of a sense that the team wasn’t doing enough to involve doctors.

“We were in the throes of the study,” recalls principal investigator Judith Long, MD, of the University of Pennsylvania. The group was meeting with their patient advisors and clinicians separately. “There was something missing from these discussions—they didn’t get at specific logistical details of the intervention and improvements we might make,” Long says. 

So the investigators decided to try a town hall meeting in which study participants could describe their experience, community health workers could explain their work, and the patient advisors and clinicians could ask questions and exchange ideas. The meetings ended up helping the research group work out logistical problems and shed light on what the stakeholders valued.

An added benefit was that the town hall meetings turned to discussing sustainability: How would the clinics continue the community health worker program once the study ended? “We laid the groundwork for the future through these meetings that really allowed us to hear from the patients and the providers,” Long says.

Engaging clinicians is a crucial element of patient-centered outcomes research. We encourage all researchers to think about how to involve both parts of the patient-clinician dyad while planning and executing clinical comparative effectiveness research.