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

为提供商开发和测试护理点共享决策工具

• 批准号: 10633183
• 负责人: DIANA N CARVAJAL
• 金额: $ 15.98万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-29 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10633183
• 关键词: Address; Adherence; Award; Baltimore; Birth; Caring; Client satisfaction; Clinical; Communication; Communities; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Decision Making; Development; Development Plans; Effectiveness; Ethnic Origin; Ethnic Population; Evaluation; Family; Family Planning; Family Practice; Feeling; Goals; Health Personnel; Health Services Accessibility; Immigrant; Immigration; Interview; Involuntary Sterilization; Knowledge; Language; Latina; Latina Population; Latino; Low income; Maryland; Measurement; Measures; Mentors; Mentorship; Methods; Minority Women; Mission; Modeling; National Institute of Child Health and Human Development; Outcome; Outcome Measure; Patient Preferences; Patient-Focused Outcomes; Patients; Perception; Persons; Phase; Planned Pregnancy; Population; Process; Property; Provider; Psychometrics; Public Health; Qualitative Methods; Qualitative Research; Race; Recording of previous events; Reporting; Reproduction; Reproductive Health; Research; Research Methodology; Research Personnel; Research Technics; Services; Specific qualifier value; Techniques; Testing; Training; Trust; Universities; Visit; Vulnerable Populations; Woman; Work; adverse outcome; care providers; career development; contextual factors; design; discounting; empowerment; ethnic discrimination; experience; group counseling; health care availability; health disparity; health goals; improved; instrument; male; medical schools; negative affect; novel; patient oriented; patient-clinician communication; people of color; point of care; preference; pregnancy prevention; pressure; prevent; professor; provider communication; public health relevance; racial population; shared decision making; skills; support tools; theories; therapy development; tool; unintended pregnancy; usability; women of color

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.

标题：改善拉丁裔移民的避孕咨询：开发和测试点 医疗服务提供者共享决策工具 首席研究员戴安娜·N·卡瓦哈尔 (Diana N. Carvajal)、医学博士、公共卫生硕士 (MPH) 是马里兰大学家庭医学助理教授 马里兰医学院的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，拟议项目将开发并测试一种针对种族的避孕药具 提高医疗保健提供者与拉丁裔移民共同决策 (SDM) 技能的咨询工具。 许多背景因素，包括移民经历、语言障碍、获得护理的机会和伴侣 的参与，可以影响拉丁裔移民的避孕决策和使用。我最近的工作在 马里兰州巴尔的摩还发现，拉丁裔移民认为与医疗服务提供者的沟通不畅 避孕优先事项对他们的决策产生负面影响。患者与提供者沟通的影响 避孕药具的使用和依从性，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 提供了一个模型，以某种方式支持患者的决策 它由患者识别的重要背景因素告知并对其做出反应。很少有支持工具专注于 提高提供者在避孕咨询期间的 SDM 技能，并且没有一个对拉丁裔有种族反应 移民。因此，我建议在与拉丁裔移民建立的关系的基础上发展 社区和巴尔的摩的提供者在我的专家导师的帮助下实现三个具体目标 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，以征求他们对以下方面的看法： a) 当前的咨询实践； b) 使用 SDM 的障碍； c) 拉丁裔移民的避孕偏好及其影响因素； d) 设计 SDM POC 工具； 2) 衡量提供者在咨询访问期间对 SDM 的使用情况和患者体验，以及 患者的治疗结果； 3) 开发并测试针对提供商的 POC 工具的可用性和可接受性 促进拉丁裔移民的 SDM。 凭借我的导师和顾问的具体专业知识和指导，我提出了职业发展计划 实现：1）扩展我的定性研究技能（Zambrana 博士和 DeForge 博士）； 2）SDM方面的专业知识和 其测量（Barnet、Duggan 和 Dehlendorf 博士）； 3）临床开发和测试技能 工具; 4) 建立仪器心理测量特性的先进研究技术技能（Drs. 巴尼特和杜根）。该培训奖将使我准备好提交 R01 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异。

项目成果

Addressing and Dismantling the Legacy of Race and Racism in Academic Medicine: A Socioecological Framework.

• DOI: 10.3122/jabfm.2022.220050r2
• 发表时间: 2022-12-23
• 期刊: JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
• 影响因子: 2.9
• 作者: Edgoose, Jennifer Y. C.;Carvajal, Diana N.;Reavis, Kristin M. P.;Yogendran, Lashika;Echiverri, Angela T.;Rodriguez, Jose E.
• 通讯作者: Rodriguez, Jose E.

Exploring the impact of mifepristone's risk evaluation and mitigation strategy (REMS) on the integration of medication abortion into US family medicine primary care clinics✰,✰✰.

• DOI: 10.1016/j.contraception.2022.01.017
• 发表时间: 2022-05
• 期刊: CONTRACEPTION
• 影响因子: 2.9
• 作者: Razon, Na'amah;Wulf, Sarah;Perez, Citlali;McNeil, Sarah;Maldonado, Lisa;Fields, Alison Byrne;Carvajal, Diana;Logan, Rachel;Dehlendorf, Christine
• 通讯作者: Dehlendorf, Christine

Contraceptive Decision-Making and the Importance of Side Effect Information Among a Sample of Latinas.

• DOI: 10.1089/whr.2021.0115
• 发表时间: 2022
• 期刊: Women's health reports (New Rochelle, N.Y.)
• 作者: Cicerchia G;Reid LD;Carvajal DN
• 通讯作者: Carvajal DN

Latina contraceptive decision-making and use: The importance of provider communication and shared decision-making for patient-centered care.

• DOI: 10.1016/j.pec.2021.03.006
• 发表时间: 2021-09
• 期刊: Patient education and counseling
• 影响因子: 3.5
• 作者: Carvajal DN;Klyushnenkova E;Barnet B
• 通讯作者: Barnet B

Implications of Overturning Roe v Wade on Abortion Training in US Family Medicine Residency Programs.

推翻罗伊诉韦德案对美国家庭医学住院医师计划堕胎培训的影响。

• DOI: 10.1370/afm.3042
• 发表时间: 2023
• 期刊: Annals of family medicine
• 影响因子: 4.4
• 作者: Wulf,Sarah;Vinekar,Kavita;Dehlendorf,Christine;Srinivasulu,Silpa;Steinauer,Jody;Carvajal,DianaN
• 通讯作者: Carvajal,DianaN