The intervention at the heart of the Whole Health Options and Pain Education, or wHOPE, study is the Whole Health Team, an interdisciplinary unit composed of a medical provider, a complementary and integrative health provider, and a health coach. Together, these clinicians provide holistic, non-pharmacological pain care grounded in VA’s broader Whole Health approach, which begins with open-ended inquiry into what matters most to each patient and proceeds through collaborative Personal Health Planning. Over twelve months, patients attended five or more collocated visits with the team’s medical and integrative providers, supplemented by eight or more health coaching visits, while weekly team huddles supported case management and care planning. In a national randomized controlled trial of 764 veterans with moderate to severe chronic pain, the Whole Health Team outperformed both modified Cognitive Behavioral Therapy for Chronic Pain and usual care in reducing pain interference and increasing use of non-pharmacological pain services, with patients also reporting greater improvements in overall health status and treatment satisfaction.

Given that demonstrated effectiveness, the research team led by Natalie Purcell, Liliana C. Moore, William C. Becker, and Karen H. Seal turned to a critical follow-up question: can this model actually be scaled? Because the Whole Health Team approach is not simply multimodal but also team-based, interdisciplinary, and integrated, requiring collocated clinical visits, routine coaching, and weekly huddles, it is more complex and resource-intensive than many other pain interventions. To investigate, the researchers conducted semi-structured interviews with 43 clinicians and staff involved in implementing the intervention, including 14 health coaches, 6 primary care providers, 6 integrative-trained providers, 5 other clinical professionals, 8 local site investigators, and 4 study coordinators. Guided by the Practical Robust Implementation and Sustainability Model, a framework that maps contextual factors from planning through sustainment, the team used template-based rapid analysis to distill themes from interviews lasting 30 to 60 minutes each.

The first major theme concerned team composition and collaboration, and here the clinicians were emphatic. They praised the interdisciplinarity of the model and described working in a genuinely integrated fashion rather than in silos. One medical provider captured the spirit of the collaboration vividly, recalling that the team was working with patients together, talking together, interrupting each other, and asking questions rather than operating separately. Collocated patient visits served as a central venue for this active collaboration, but so did the weekly huddles between visits, where hearing one another’s perspectives helped the team generate multiple options when patients faced challenges. A complementary and integrative health clinician noted that a single lens might not be the best thing for the patient, and expressed appreciation for the ability to hear the same piece of information and encounter completely different perspectives on how to manage it. Clinicians also believed that visible collaboration increased veteran engagement, with one coach observing that simply knowing the team was working together on their behalf gave patients another layer of buy-in.

Consistency of team membership emerged as another essential ingredient. Clinicians stressed that building trust with patients requires time and continuity, and that the twelve-month structure of regular clinical and coaching visits cultivated increased trust, deeper rapport, and genuine continuity of care. Patients came to depend on a familiar team they got to know, which in turn facilitated active involvement in care planning. Yet sustaining that consistency proved difficult. Because clinicians were volunteers lending their time from other duties, they were sometimes pulled off the study to devote resources elsewhere, a problem amplified during the COVID-19 pandemic during which all study interventions were delivered virtually. Clinician turnover interrupted care relationships and left key roles vacant at times, burdening remaining team members and making it harder to practice with a Whole Health approach. Interviewees stressed that team stability must be prioritized if relationship-based care is to survive contact with real-world staffing pressures.

Adequate, formally allocated clinician effort was perhaps the most contested resource of all. The Whole Health Teams operated in an institutional environment focused on optimizing productivity, where bookable hours were measured closely and every clinic scheduling grid was scrutinized. Both clinicians and site investigators emphasized the importance of protected time for team work, including dedicated clinic hours, time for writing notes, and time for the weekly huddles they considered critical. All participating sites did secure protected time, but doing so required staunch advocacy amid competition for clinical resources, and maintaining it remained an ongoing challenge. One site investigator described it as probably the biggest obstacle the team had faced. Clinicians also valued formal orientation to the team, which covered roles, visit protocols, and documentation requirements, though some, including several medical providers, retained uncertainty about their prescribing role relative to patients’ primary care providers, underscoring the need for clearly delineated responsibilities in interdisciplinary teams.

The second major theme involved organizational infrastructure and integration, beginning with the need to fill gaps rather than duplicate existing services. Because some VA health systems already offer pain-management and wellness programs, clinicians and investigators argued that the more resource-intensive Whole Health Team model must demonstrate unique value to make a viable business case for sustainment. They found that value in delivering an integrated, consistent message to each patient. One medical provider lamented that the health system is so fractured that patients see different people who tell them different things, and described the team as an efficient and effective way to help patients with a coherent care plan, noting that veterans like to see that their clinicians are all on the same page. The model also improved the clinicians’ own work experience, fostering mutual support and confidence when caring for patients with complex needs. At the same time, interviewees identified shortcomings: coordination with primary care sometimes felt informal, relying on discretionary co-signature of notes that primary care providers did not always read, and referral pathways to wellness and complementary modalities were often poorly mapped, forcing coaches to act as conduits to information that higher-level staff knew less and less about.

The third theme centered on administration and documentation, an unglamorous but decisive factor. Implementing collocated visits and concurrent health coaching is administratively complicated, and each site benefited from a study-funded, full-time coordinator who scheduled meetings and patients, set up clinic grids, collected point-of-care measures, tracked visits, completed documentation, made reminder calls, and served as an information hub for the whole team. One coordinator cautioned bluntly that if the model were implemented elsewhere, the level of administrative support provided in the study simply would not be available in a clinical service. Clinicians also chafed against standardized clinical note templates designed for study data collection, which felt ill-suited to personalized whole-person care. One provider asked why they needed to do math during a visit and take time away from listening to a veteran’s story, while another complained that templates force a robotic style that annoys patients. The consensus favored simpler, more flexible documentation that could adapt to each visit’s focus.

Perhaps the most striking finding was the depth of clinicians’ belief in the Whole Health model despite every implementation hurdle. Interviewees described practicing in line with their own values, connecting with patients more authentically, and witnessing emotional exit visits in which patients felt deeply cared for and equipped with new resilience and tools. One provider offered a sentiment that captures the model’s philosophy: patients are people, more than just a list of diagnoses, and they are fun and complicated. These accounts align with broader evidence that Whole Health practice may reduce clinician stress and burnout, and with VA survey findings that clinicians engaged in Whole Health view their workplaces more favorably and are less likely to resign. Yet many participants doubted the system would retain and spread the teams, perceiving the model as resource-intensive in an environment that rewards volume and perceived efficiency over quality, experience, and outcomes. They saw the teams as an upstream investment with downstream benefits, but acknowledged that a comprehensive longer-term cost-effectiveness analysis may be needed, particularly as an alternative to interventional pain care.

The study’s lessons amount to a practical blueprint for any health system contemplating integrated, person-centered pain care. Success requires consistent team membership, sufficient protected clinical effort, well-defined roles, team-based training, routine huddles, and skilled administrative support that could be provided by a nurse care manager or medical support assistant in the absence of a study coordinator. It also demands organizational readiness: accessible complementary and integrative health modalities, wellness programs, and health coaching, along with clear referral pathways connecting pain teams to those resources. Deeper integration with primary care, through periodic in-services or coaches already embedded in primary care, could strengthen both patient care and sustainability. As VA continues its transformation into a Whole Health System of Care, and as other integrated systems such as Kaiser Permanente pursue similar holistic models, the wHOPE findings illuminate both the promise and the price of treating chronic pain as a whole-person problem, offering hard-won insight into a care model that the clinicians who delivered it clearly believe is worth sustaining.

Subject of Research: Implementation of interdisciplinary whole-person chronic pain care in the Veterans Affairs Whole Health Team model

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

Article References: Purcell, N., Moore, L. C., Becker, W. C., & Seal, K. H. (2026). Implementing Integrated Whole-Person Care for Chronic Pain: Lessons from VA’s Multisite wHOPE Study. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10825-5

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10825-5

Keywords: chronic pain, Whole Health, Veterans Affairs, interdisciplinary care, implementation science, complementary and integrative health, health coaching, multimodal care, biopsychosocial, qualitative research, primary care, clinician burnout