Shared Decision-Making to Reduce Racial Disparities in Oral Anticoagulation Use in Patients with Non-Valvular Atrial Fibrillation

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Blacks with non-valvular atrial fibrillation (NVAF) are less likely to receive oral anticoagulants (OAC) for stroke prevention compared with Whites. This is notable given that Blacks have a 3-fold greater risk of NVAF-related ischemic stroke compared to Whites. My long-term goal is to reduce racial disparities in arrhythmia (defined as an abnormal heart rhythm) care. My goal in applying for a Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research is to acquire the research skills and hands-on experience necessary to become a productive, independent, clinician-scientist. My research focuses on addressing racial disparities in the use of OAC in patients with NVAF. Candidate and Mentors: I am an Assistant Professor of Medicine at Duke University’s School of Medicine where I practice as an cardiac electrophysiologist. My primary mentor, Dr. Kevin Thomas, has expertise in healthcare disparities, specifically the contributors to lower quality of health care delivery and outcomes among racial and ethnic minority populations. Research and Training: The goal of this research proposal is to develop a patient decision support tool aimed at facilitating shared decision making, improving decision quality, and increasing the uptake of OAC in Blacks with NVAF. Shared decision making, aided through the use of patient decision support tools, has been associated with improved outcomes including increased knowledge, less decisional conflict, and increased uptake of therapeutic interventions. Unfortunately, Blacks are more likely to experience non-participatory decision making than non-racial and ethnic minority populations. In this proposal, I will: 1) conduct interviews among Black and White patients with NVAF and clinicians to understand the barriers and facilitators toward participating in shared decision making regarding use of OACs; 2) develop and iteratively evaluate a patient decision support tool; and 3) conduct a pilot study to assess the feasibility and acceptability of a patient decision support tool to facilitate shared decision making. The training plan will prepare me for a career aimed at addressing racial disparities in arrhythmia care and will include education in 1) implementation science to promote the adoption of our patient decision support tool in clinical practice; 2) accruing skills in the design and testing of patient decision support tools; and 3) design of clinical trials to assess the efficacy of our intervention. This research will provide data to support a R01 proposal to test the efficacy of a patient decision support tool to improve shared decision making, decision quality, and potentially increase the use an adherence of OAC in Blacks in a multisite randomized clinical trial. Summary: The proposed research will lead to the development of a patient decision support tool intervention used to facilitate shared decision making in Blacks with NVAF, improve decision quality, and potentially increase the uptake of OAC in Blacks with NVAF. The K01 Diversity award will support my development into a leader in healthcare disparities research with the goal of promoting patient-centered care by empowering patients to make informed, values- based decisions needed to improve decision quality and potentially reduce racial disparities in arrhythmia care.