loading
loading
NIH grant 1IK2RD000389-01A1: Equitable Implementation of Buprenorphine for Chronic Cancer Pain
Institute: {'code': 'VA', 'abbreviation': 'VA', 'name': 'Veterans Affairs', 'admin_org_id': '12500964', 'admin_funding_url': ''}. PI: Katie Fitzgerald Jones. Award: $.
Start: 2026-10-01T00:00:00.
Significance to the VA: VA initiatives to curb high-risk opioid prescribing are unintentionally compromising
chronic cancer pain management. More than one in three Veterans with cancer suffer from chronic cancer
pain, which can be due to cancer, its treatment, or pre-existing chronic pain (which typically worsens after
cancer diagnosis). Chronic cancer pain negatively impacts Veteran well-being and is associated with poor
quality of life, cancer-related suicide, intolerance of cancer treatment, and increased mortality. Opioids are the
foundation of chronic cancer pain management, but due to concerns of the risk associated with full agonist
opioids among Veterans, opioid prescribing rates in Veterans with cancer are declining.
Buprenorphine, a partial opioid agonist, is a safer evidence-based treatment for chronic cancer pain, either with
or without comorbid Opioid Use Disorder (OUD). Buprenorphine is the preferred opioid therapy for
chronic cancer pain according to the 2022 VA/DoD Clinical Practice Guideline for the Use of Opioids in
the Management of Chronic Pain. Despite its efficacy and side effect profile, buprenorphine is rarely used to
treat chronic cancer pain (<1% of all Veterans with cancer receive buprenorphine). Barriers to buprenorphine
implementation for OUD are well-described. However, barriers and facilitators for equitable buprenorphine
implementation for chronic cancer pain have not been studied.
Innovation and Impact: This proposal focuses on buprenorphine implementation in Veterans with chronic
cancer pain, either with or without OUD. This is a population with a high burden of pain and suffering that
requires management with opioid therapy, often until the end of life. The proposed study is responsive to VA
legislative mandates (the CARA and PACT Act) by promoting best practices in chronic pain management,
implementing opioid prescribing responsibly and safely, and focusing on the care of service-related chronic
conditions. The study directly aligns with the priorities of the VA Secretary and Health Systems Research.
Specific Aims: Aim 1: Assess barriers and facilitators to buprenorphine implementation in Veterans
with chronic cancer pain. We will conduct qualitative interviews and rapid qualitative analysis with up to 40
key stakeholders (Veterans, VA staff, including clinicians and leaders) from four VA sites. Interviews and
analysis will be guided by the updated Consolidated Framework for Implementation Science (CFIR).
Aim 2: Develop and adapt implementation strategies to support buprenorphine implementation in
Veterans with chronic cancer pain to fit local context and end-user preferences. We will integrate
modified co-design methods into Implementation Mapping to develop and adapt buprenorphine implementation
strategies that best address the local conditions at two of the VA sites that participated in Aim 1.
Aim 3: Conduct a pilot trial to determine feasibility, acceptability, appropriateness, adoption, and
penetration of buprenorphine implementation for chronic cancer pain. The six-month pilot will take place
at the same two sites as Aim 2. Guided by Proctor’s implementation taxonomy, we will quantitatively and
qualitatively assess implementation outcomes of buprenorphine and of the implementation strategies.
Methodology: We will use Implementation Mapping and co-design principles that select and tailor
implementation strategies to the local context and engage end-users.
Path to Translation/Implementation: The proposed research is the first step to increasing buprenorphine
implementation. During the study procedures, we will develop multiple products for dissemination, which can
increase clinician and Veteran knowledge of buprenorphine. Study results will also provide preliminary data for
future research focused on chronic cancer pain, including a large-scale buprenorphine implementation
randomized controlled trial. The study findings will be used to address and improve care delivery gaps in pain
management and opioid access among Veterans suffering from chronic cancer pain.document fetched 2026-10-24 02:46