Development and Testing of a Point-of-Care Shared Decision-Making Tool for Providers

标题：改善对拉丁裔移民的避孕咨询：开发和测试一个时间点 医疗服务提供者的关怀共享决策工具 The PI，Diana N.Carvajal，医学硕士，加州大学家庭医学助理教授 马里兰医学院，临床和研究重点是改善计划生育结果 弱势群体。她的长期目标是成为女性生殖领域的独立研究员和领导者 健康，重点是降低弱势群体的意外怀孕率和相关不良后果 人口。为此，拟议的项目将开发和测试一种对种族反应敏感的避孕药 咨询工具，以提高医疗保健提供者与拉美裔移民的共享决策(SDM)技能。 许多背景因素，包括移民经历、语言障碍、获得护理的机会和合作伙伴 参与，可以影响拉美裔移民的避孕决策和使用。我最近在 马里兰州巴尔的摩还发现，拉美裔移民认为与供应商就 避孕优先事项对他们的决策产生了负面影响。患者与提供者之间的沟通影响 避孕措施的使用和坚持，以及在避孕期间提供以患者为中心的沟通 咨询与SDM方法是一致的。SDM在某种程度上提供了一种支持患者决策的模型 这是由患者识别的重要背景因素提供信息并对其做出回应。很少有支持工具专注于 在避孕咨询期间提高提供者的SDM技能，而且没有人对拉丁裔做出种族反应 移民。因此，我建议与拉美裔移民建立已建立的关系 社区和巴尔的摩的供应商，在我的导师的帮助下实现三个具体目标 计划生育、医患沟通、干预发展和评估。我会：1) 对提供者进行定性研究，以了解他们对以下问题的看法：a)当前的咨询做法；b) 使用SDM的障碍；c)移民拉丁裔人的避孕偏好及其影响因素；d)设计 SDM POC工具；2)在咨询访问和患者体验期间测量提供者对SDM的使用和体验 患者结果；3)开发和测试针对提供商的POC工具的可用性和可接受性，以 促进拉美裔移民的SDM。 在我的导师和顾问的具体专业知识和指导下，我提出了一项职业发展计划 实现：1)扩展我的定性研究技能(赞布拉纳博士和德福格博士)；2)SDM和 它的测量(巴内特、达根和德伦多夫博士)；3)开发和测试临床应用的技能 工具；以及4)先进研究技术的技能，以确定仪器的心理测量学特性(Dr。 Barnet和Duggan)。此培训奖将为我提交R01做好准备，以测试工具在 大规模随机对照试验--有可能减少意外怀孕和相关的健康差距。

Title: Improving Contraceptive Counseling for Immigrant Latinas: Development and Testing of a Point-of- Care Shared Decision-Making Tool for Providers The PI, Diana N. Carvajal, MD MPH, is an Assistant Professor of Family Medicine at the University of Maryland School of Medicine with a clinical and research focus on improving family planning outcomes for vulnerable populations. Her long-term goal is to be an independent researcher and leader in women’s reproductive health, focused on decreasing rates of unintended pregnancy and associated adverse outcomes for vulnerable populations. To that end, the proposed project will develop and test an ethnically-responsive contraceptive counseling tool to improve healthcare providers’ shared decision-making (SDM) skills with Latina immigrants. Many contextual factors including immigration experiences, language barriers, access to care, and partner involvement, can influence the contraceptive decision-making and use of Latina immigrants. My recent work in Baltimore, MD has also found that Latina immigrants perceive poor communication with providers about contraceptive priorities as negatively affecting their decision-making. Patient-provider communication impacts contraceptive use and adherence, and the provision of patient-centered communication during contraceptive counseling is consistent with an SDM approach. SDM provides a model to support patient decisions in a way that is informed by and responds to important patient-identified contextual factors. Few support tools focus on improving providers’ SDM skills during contraceptive counseling, and none are ethnically-responsive to Latina immigrants. Therefore, I propose to build upon established relationships with the immigrant Latino community and with providers in Baltimore to achieve three specific aims with help from my mentors who are experts in family planning, patient-provider communication, and intervention development and evaluation. I will: 1) conduct a qualitative study of providers to elicit their perspectives about: a) current counseling practices; b) barriers to use of SDM; c) immigrant Latinas’ contraceptive preferences and factors for these; and d) the design of an SDM POC tool; 2) measure provider use and patient experience of SDM during counseling visits and patient outcomes; 3) develop and test the usability and acceptability of a provider-targeted POC tool to facilitate SDM with Latina Immigrants. With specific expertise and guidance from my mentors and advisors, I propose a career development plan to achieve: 1) expansion of my qualitative research skills (Drs. Zambrana and DeForge); 2) expertise in SDM and its measurement (Drs. Barnet, Duggan, and Dehlendorf); 3) skills in the development and testing of clinical tools; and 4) skills in advanced research techniques to establish psychometric properties of instruments (Drs. Barnet and Duggan). This training award will prepare me to submit an R01 to test the tool’s effectiveness in a large-scale RCT –with the potential to decrease unintended pregnancy and associated health disparities.