Background <p>Chronic pain disproportionately affects older adults (age ≥ 65 years), and almost half of the United States older adult population reports chronic pain. Chronic pain is associated with decreased physical function and impairs activities of daily living. Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO^® (I-COPE) was designed to develop effective pain management by studying patient goals, preferences, and comorbidities. I-COPE collects patient-reported data, implements clinical decision support tools, and provides primary care clinician education on evidence-based chronic pain treatments.</p> Objective <p>To explore the perspectives of older adults receiving chronic pain management in primary care and their views on I-COPE.</p> Design <p>I-COPE was implemented at 36 clinics within two healthcare systems in Chicago metropolitan area. Patients who met study criteria were invited to participate in semi-structured interviews.</p> Participants <p>Sixteen older adult patients with a high pain score, chronic pain, or opioid use disorder in the last year.</p> Approach <p>Patients were interviewed about their experiences with chronic pain management and their opinions about I-COPE until theme saturation was reached.</p> Key results <p>Participants described the effects of chronic pain, impacting mobility, daily activities, sleep, relationships, and wellbeing. Participants desired improved daily functioning, pain, and independence. They preferred treatments that increased physical activity, limited medications, and were not surgeries/procedures. During treatment decision-making, patients considered clinician recommendations, their goals, and current/past treatment effectiveness. Pain management satisfaction was associated with elements of shared decision making. Overall, participants believed that I-COPE tools could enhance clinician understanding of pain.</p> Conclusions <p>Older adult patients with chronic pain share pain management goals and treatment preferences similar to those reported in studies of primary care clinicians. Greater satisfaction with pain management was associated with shared decision-making principles. Patients held favorable opinions towards I-COPE in addressing barriers to pain management.</p> Trial registration <p>The study was registered at ClinicalTrials.gov under #NCT04878562 on May 4, 2021.</p>