Behavioral and Social Science Research on Understanding and Reducing Health Dispa

描述(由申请人提供)：许多研究证明，在骨关节炎(OA)的治疗中，关节置换术的使用存在明显的种族/民族差异。非裔美国人(AA)接受下肢骨关节炎关节置换术的可能性比白人患者低约40%，根据疾控中心的最新报告，这种差异是持久的。我们的研究团队发表的证据表明，与类似的白人患者相比，AA关节置换候选患者对关节置换的偏好不同，这些差异主要是由于对治疗风险/好处的知识和理解以及对手术结果的期望的差异。此外，对偏好敏感的治疗，如关节置换，医患沟通是双向的，沟通的内容和决定受到患者的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再生障碍性贫血患者与骨科医生之间的沟通质量，从而降低再生障碍性关节炎患者接受关节置换建议的可能性。需要更多的研究来评估特定的干预措施，以帮助AA患者与骨科医生进行沟通，并提高他们在临床指示时接受膝关节置换建议的可能性。我们建议一项随机对照试验，以评估高质量、以证据为基础、以患者为中心的教育干预和有针对性的咨询对AA患者与骨科医生之间的沟通质量的影响，以及在临床指示时接受膝关节置换建议的可能性。已被转介至骨科手术的潜在膝关节置换候选AA患者将被随机分为两组，一组接受使用膝盖骨关节炎决策辅助(DA)的教育干预，另一组接受使用动机访谈(MI)技术的简短咨询的教育干预，或者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，以及在干预后6个月内收到膝关节置换建议的可能性。这项建议的中心假设是，通过在做出决策时提供高质量的、基于证据的、以患者为中心的教育干预，可以更好地向患者提供信息，从而改善骨科医生与患者之间关于关节置换的沟通和决策。因此，这项建议的主要具体目标是：1)检查干预对AA患者与骨科医生沟通质量的影响，以及2)检查干预对在临床指示时收到膝关节置换建议的可能性的影响。

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.