Engaging Clinical Partners in Pragmatic Clinical Trials: Lessons Learned from the Pain Management Collaboratory

46 potential roles for clinical partners include sharing clinical responsibilities when possible and 47 providing practical insights for pragmatic trial researchers planning studies that reflect and 48 address real-life conditions.49 50 Clinical staff availability to participate in pragmatic research is a significant issue in health 51 settings that serve military members and veterans.Ongoing conversations with PMC trial teams 52 have pointed to frequent turnover of military clinicians in Department of Defense (DOD)-funded 53 trials -and within Department of Veterans Affairs (VA)-funded trials, a shortage of clinicians to 54 participate in research due to heavy patient loads and insufficient back-up support.Limitations in 55 clinical staff availability to participate in pragmatic research are exacerbated by administrative 56 delays to replace and onboard key clinical staff.As one way to address these issues, several PMC 57 trials developed mentorship programs whereby personnel from sites meeting ongoing 58 recruitment targets and other milestones helped to onboard and mentor clinical personnel at other 59 study sites.These personnel included clinic providers, research personnel, technicians, and front 60 desk staff.PMC trial leaders hired appropriately credentialed research clinicians to deliver 61 virtual interventions or to offset clinician workload by caring for patients who were not enrolled 62 in the study.PMC teams also worked to ensure that trial interventions counted toward a 63 provider's workload.64 65 Clinicians who deliver care in military and veteran health facilities often have multiple roles and 66 responsibilities and are not compensated financially for participating in research.PMC 67 investigators observed clinicians' altruistic motivations to participate in clinical research can be 68 weakened by additional burdens, such as institutional review board (IRB)-related paperwork and