Behavioral and Social Science Research on Understanding and Reducing Health Dispa

了解和减少健康障碍的行为和社会科学研究

• 批准号: 8288275
• 负责人: Said A Ibrahim
• 金额: $ 45.91万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-22 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8288275
• 关键词: African American; Attention; Attitude; Benefits and Risks; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Client satisfaction; Clinical; Communication; Control Groups; Counseling; Decision Aid; Decision Making; Degenerative polyarthritis; Disease Management; Educational Intervention; Foundations; Generations; Goals; Health; Intervention; Joints; Knee Osteoarthritis; Knee joint; Knowledge; Lead; Lower Extremity; Medical; Minority; Modeling; Operative Surgical Procedures; Orthopedic Surgery procedures; Orthopedics; Outcome; Patients; Pattern; Process; Publishing; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Replacement Arthroplasty; Reporting; Research; Research Design; Roter; Shapes; Societies; Staging; Surgeon; Systems Analysis; Techniques; Time; administrative database; base; behavioral/social science; design; disability; effective therapy; empowered; evidence base; expectation; improved; intervention effect; knee replacement arthroplasty; meetings; motivational enhancement therapy; patient oriented; preference; public health relevance; racial and ethnic disparities; social science research

DESCRIPTION (provided by applicant): Numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of joint replacement in the management of osteoarthritis (OA). African-Americans (AA) are about 40 percent less likely than white patients to receive joint replacement for lower extremity OA, and this disparity is enduring based on the latest report from the CDC. Our research team published evidence demonstrating that, compared to similar white patients, AA candidates for joint replacement differ in their preferences for joint replacement and that these differences are primarily shaped by differences in knowledge and understanding about the treatment risks/benefits and expectations about surgical outcomes. Furthermore, doctor-patient communication for preference-sensitive treatments such as joint replacement is bi-directional and the content of the communication and the decisions are influenced by patient's baseline attitudes and preferences as well as their ability to engage in the discussion. There is preliminary evidence that baseline differences in preference, knowledge, and expectations regarding this treatment impact the quality of communication between AA patients and orthopaedic surgeons and consequently reduce AA patients' likelihood of receiving a recommendation for joint replacement. More research is needed to assess specific interventions to help empower AA patients in their communication with orthopaedic surgeons and improve their likelihood of receiving a recommendation for knee replacement when clinically indicated. We propose a randomized controlled trial is to assess the effect of a high-quality, evidence-based, patient-centered educational intervention supplemented with targeted counseling on the quality of communication between AA patients and orthopaedic surgeons and on the likelihood of receiving a recommendation for knee joint replacement when clinically indicated. AA patients who are potential candidates for knee joint replacement who have been referred to orthopaedic surgery will be randomized to undergo either an educational intervention using the Knee OA Decision Aid (DA) supplemented with brief counseling using the Motivational Interviewing (MI) technique or an attention control treatment. We will assess the effect of the intervention on quality of doctor- patient communication and likelihood of receiving a recommendation for knee joint replacement within 6 months of the intervention. The central hypothesis of this proposal is that orthopaedic surgeon-patient communication and decision-making about joint replacement can be improved by better informing the patients using a high quality, evidence-based, patient-centered educational intervention delivered at the time of decision-making. Therefore, the primary specific aims of this proposal are: 1) To examine the effect of the intervention on the AA patient's quality of communication with the orthopaedic surgeon, and 2) To examine the effect of the intervention on the likelihood of receiving a recommendation for knee joint replacement when clinically indicated. PUBLIC HEALTH RELEVANCE: Numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of knee replacement, an effective and highly utilized treatment option for advanced knee osteoarthritis. This study will provide one of the first patient-centered interventions in the orthopedic setting designed to mitigate racial/ethnic disparity in access to joint replacement for patients who meet clinical indications for the treatment. The results of this study will not only inform the nation on strategies to reduce or eliminate one of most marked disparities in chronic disease management, but will also provide opportunities to improve quality of care for large segment of our society.

描述（由申请人提供）：大量研究证明，在骨关节炎（OA）治疗中，关节置换术的应用存在明显的种族/民族差异。非洲裔美国人（AA）接受下肢OA关节置换术的可能性比白人患者低40%左右，根据疾病预防控制中心的最新报告，这种差距正在持续下去。我们的研究小组发表的证据表明，与相似的白人患者相比，关节置换术的AA候选人在关节置换术的偏好上存在差异，这些差异主要是由对治疗风险/益处的知识和理解以及对手术结果的期望的差异造成的。此外，对于偏好敏感治疗（如关节置换术），医患沟通是双向的，沟通和决策的内容受到患者基线态度和偏好以及他们参与讨论的能力的影响。有初步证据表明，对这种治疗的偏好、知识和期望的基线差异会影响AA患者和骨科医生之间的沟通质量，从而降低AA患者接受关节置换术推荐的可能性。需要更多的研究来评估具体的干预措施，以帮助AA患者与骨科医生沟通，并提高他们在临床指征时接受膝关节置换术建议的可能性。我们建议进行一项随机对照试验，以评估高质量、循证、以患者为中心的教育干预，并辅以有针对性的咨询，对AA患者与骨科医生之间的沟通质量和临床指征时接受膝关节置换术推荐的可能性的影响。已转介骨科手术的有可能进行膝关节置换术的AA患者将被随机分为两组，一组接受使用膝关节OA决策辅助（DA）辅助的教育干预，另一组接受使用动机性访谈（MI）技术的简短咨询，另一组接受注意力控制治疗。我们将评估干预对医患沟通质量的影响，以及干预后6个月内接受膝关节置换术建议的可能性。本提案的中心假设是，通过在决策时提供高质量、循证、以患者为中心的教育干预，更好地告知患者，可以改善骨科医生与患者关于关节置换术的沟通和决策。因此，本提案的主要具体目的是：1)检查干预对AA患者与骨科医生沟通质量的影响；2)检查干预对临床指征时接受膝关节置换术建议的可能性的影响。