Addressing Contextual Factors in Chronic Disease Management in Minority Older Adults through Photo-based Patient-Clinician Communication

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PROJECT SUMMARY AND ABSTRACT By 2050, 42% of the older U.S. population will be racial/ethnic minorities. Older minorities bear a substantial burden of multiple chronic conditions (MCC) and receive poorer quality of chronic disease management. Patient-clinician communication barriers are important contributors to disparities in care and outcomes of MCC. In particular, clinical visit communication about the context of people’s lives (i.e., contextual factors such as medication use, dietary habits, fall risk and social support) optimally informs MCC management and is vital to delivering patient-centered care. Yet, few patient-clinician communication interventions have included diverse older adults with MCC, and most do not address the interactions of aging, MCC and contextual factors that enhance or reduce health. A common scenario is the minority older adult with diabetes and concurrent comorbid conditions. The burden of self-management tasks related to diabetes (e.g., checking glucose, taking medications, adhering to diet) while simultaneously following care plans for other conditions can be overwhelming, particularly when care plans do not account for the context of patients’ daily lived experiences. The overarching goal of this proposal is to overcome disparities in patient-clinician communication among older minorities with MCC by developing a patient-centered technology-based communication intervention called Photo+Care. The premise of Photo+Care is that a picture is worth a thousand words, meaning that photos can promote efficient information exchange and activate patients to communicate their lived experiences to their clinicians, so they can develop patient-centered care plans together. Using smartphone cameras as a tool, Photo+Care will elicit and integrate 4 contextual factors (medication use, dietary habits, fall risk and social support) into primary care for older minority adults with MCC. Photo+Care will consist of a patient component, comprising: 1) brief training on how to take photos using a smartphone; and 2) standardized, structured and open-ended prompts to guide what kind of photos to take to describe 1 of the 4 contextual factors. The clinician component includes brief training on: 1) how to respond to photos shared by patients; and 2) how to discuss contextual factors elicited by the photos. The patient-clinician component is when patients briefly share select photos with clinicians during a clinic visit. The career goal of the candidate, Dr. Jane Jih, is to be a leader in the national mission to achieve health equity and a research expert on health disparities among older adults. Her short-term goals are to gain additional skills necessary to develop and test patient-centered interventions that improve outcomes for multiethnic and linguistically diverse older adults. To support her career development, Dr. Jih has assembled an exceptional multidisciplinary mentoring team including Dr. Christine Ritchie, a geriatrician with MCC expertise and Dr. Tung Nguyen, a national leader in Asian American health. This award will advance knowledge of patient-centered approaches to enhance the care of older adults, and allow Dr. Jih to receive additional training to become a leader in disparities and aging research.