Improving Decision Making in Patients with Rheumatic Disease

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 DESCRIPTION (provided by applicant): The goals of the proposed research activities are 3-fold: 1) to support my continued impact as a mentor, 2) to further grow the clinical research training program in the Section of Rheumatology at my institution, and 3) to continue to advance my own patient-oriented research (POR) program in medical decision making. My commitment to mentoring is the primary reason I am applying for a renewal of the K24 Award. Requests for mentoring continue to increase, and a renewal of this award would ensure that I have the protected time to be able to continue to encourage, support, teach, and advise trainees from various backgrounds interested in a future career involving POR. While my primary interest is in the field of decision making, my training and has allowed me to be an effective mentor for trainees interested in other aspects of rheumatologic research. The K24 award has been critical in the establishment a clinical research training program in the Section of Rheumatology. We now have a systematic approach to help trainees at various levels develop an individualized development plan, engage in the appropriate didactic and experiential research activities and monitor their progression towards their specific goals. Trainees who have already undergone basic training have the opportunity to take more advanced courses and to obtain a Masters' degree in Health Sciences or PhD in Investigative Medicine. Newly acquired resources include The Yale Patient-Centered Outcomes Research Scholars Program interdisciplinary mentored K12 career development program funded by AHRQ, which focuses on developing investigators with an interest in comparative effectiveness research methods. The Rheumatology POR training program includes formal processes for evaluation of both trainees and mentors. Based on our experience over the past four years, we will initiate several important changes to improve the program including advancing didactic training to the first year of fellowship, decreasing fellows' clinical responsibilities during their second year of fellowship, and adding two activitie: 1) peer led review of essential skills (e.g., development of specific aims, abstract presentations) and 2) formal grant mock reviews. In addition to mentoring young investigators, one of my important long-term goals is to advance my own research agenda so that I can continue to conduct scientifically rigorous and meaningful POR. Over the past four years, I have published papers which highlight the consequences of poor decision making in clinical practice, describe the differences in how patients and physicians approach critical decisions, and demonstrate the efficacy of a theory-based decision support tool in a randomized controlled trial. My recent work has also demonstrated the limitations associated with reporting preferences in the aggregate and the impact of low numeracy on risk perceptions. My goals during the next phase of my career are to develop better methods to 1) measure and report heterogeneity in patient preferences, and 2) develop novel approaches to effectively communicate risk-benefit information to patients by obtaining further training and conducting novel research.