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

标题：改善拉丁移民的避孕咨询：一个点的发展和测试， 面向提供者的护理共享决策工具 PI，Diana N。Carvajal，医学博士，公共卫生硕士，是一个家庭医学助理教授在大学的 马里兰州医学院的临床和研究重点是改善计划生育的结果， 弱势群体。她的长期目标是成为女性生殖健康领域的独立研究者和领导者。 健康，重点是降低意外怀孕率和相关的不利后果， 人口。为此，拟议的项目将开发和测试一种对种族敏感的避孕药具。 咨询工具，以提高医疗保健提供者的共同决策（SDM）与拉丁美洲移民的技能。 许多背景因素，包括移民经历，语言障碍，获得护理和伴侣 参与，可以影响避孕决策和使用的拉丁美洲移民。我最近的工作 医学博士巴尔的摩还发现，拉丁裔移民认为与供应商沟通不畅， 避孕优先事项对她们的决策产生负面影响。患者-提供者沟通影响 避孕药的使用和依从性，以及在避孕期间提供以患者为中心的沟通 咨询与SDM方法一致。SDM提供了一种模型，以某种方式支持患者决策 其由重要的患者识别的背景因素告知并响应于重要的患者识别的背景因素。很少有支持工具专注于 在避孕咨询过程中提高提供者的SDM技能，没有一个对拉丁裔有种族反应。 移民.因此，我建议建立在与移民拉丁美洲人建立关系的基础上， 社区和供应商在巴尔的摩，以实现三个具体目标的帮助下，我的导师谁是专家， 计划生育、医患沟通以及干预措施的制定和评估。我会：1） 对提供者进行定性研究，征求他们对以下问题的看法：a）当前的咨询实践; B） 使用SDM的障碍; c）拉丁移民的避孕偏好和因素;以及d）设计 SDM POC工具; 2）测量咨询访问期间SDM的提供者使用和患者体验， 患者结局; 3）开发并测试针对提供商的POC工具的可用性和可接受性， 为拉丁裔移民提供SDM服务。 在导师和顾问的具体专业知识和指导下，我提出了一个职业发展计划， 实现：1）扩展我的定性研究技能（Zambrana和DeForge博士）; 2）SDM专业知识， 其测量（Barnet，Duggan和Dehlendorf博士）; 3）临床开发和测试的技能 工具;和4）在先进的研究技术，以建立仪器的心理测量特性的技能（博士。 Barnet和Duggan）。这个培训奖将准备我提交一个R 01，以测试该工具的有效性， 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.