Developing and Pilot Testing a Decision Aid for Opioid Use Disorder Treatment with Incarcerated Individuals Anticipating Release

这项申请寻求五年的医生科学家出现作为一个独立的病人为中心 决策科学研究人员在物质使用障碍和传染病的交叉，特别是 在刑事司法人口中。该申请提出了一个精心安排的课程， 相关的研究项目，将由决策科学和病人的领先专家监督 偏好、成瘾医学、刑事司法、生物统计学和艾滋病毒预防。候选人选择了 重点关注艾滋病毒感染者或有感染风险的人非常脆弱的时期--释放后的过渡期 从监禁中解脱出来考虑到挥发性阿片类药物的流行助长了过量的阿片类药物，这是特别及时的- 与过量用药和艾滋病毒和丙型肝炎病毒的传播有关。阿片类药物使用障碍并发症的风险为 特别是在从监狱和监狱过渡期间;康涅狄格州所有过量死亡的52% 最近被释放的囚犯。阿片类药物使用障碍的治疗和释放后的维持 是解决阿片类药物负面影响的最有效策略之一 疫情然而，对于患有阿片类药物使用障碍的囚犯来说，他们往往过于乐观，认为他们不再 需要治疗或没有足够的信息来指导他们选择可用的治疗方法。决策辅助 是以证据为基础的战略，以更有效地让患者（和提供者）参与治疗。决定 对其他条件和环境的帮助已经被证明可以提高知识和选择， 更好地符合患者的价值观和偏好，从而增加启动和保留的可能性， 循证护理。候选人计划调整她为社区开发的决策辅助工具 从监禁到过渡期的治疗环境。这种援助旨在改善患者和 提供者的知识和态度，以克服对治疗的错误信息和负面情绪。适应 目前的阿片类药物使用障碍（OUD）治疗的决策援助，候选人建议进行混合- 对患有OUD的被监禁者和多学科司法系统工作人员进行方法评估， 关于OUD治疗的共同决策和释放前的药物启动。通知 根据这些结果，她将（使用系统框架）调整现有的基于平板电脑的OUD决策辅助工具 可用性/现场测试治疗。这最终确定和新的决定援助被监禁的个人预计 将试行释放，以评估被监禁个人和工作人员的可行性和可接受性， 以及试验的可行性和与 像往常一样咨询。这些拟议的目标将得到一项指导和培训计划的支持， 这将支持候选人的最终发展成为一个独立的研究人员与最终的R 01 提交以病人为中心的药物使用和传染病研究。

This application seeks five years for a physician-scientist to emerge as an independent patient-centered decision science researcher in the intersection of substance use disorders and infectious diseases, especially within criminal justice populations. The application proposes a combination of carefully timed coursework and related research projects that will be supervised by leading experts in decision science and patient preferences, addiction medicine, criminal justice, biostatistics and HIV prevention. The candidate has chosen to focus on an incredibly vulnerable time for people with or at risk for HIV – the transitional period after release from incarceration. This is especially timely given the volatile opioid epidemic that has fueled excessive opioid- related overdoses and transmission of HIV and HCV. The risk for complications from opioid use disorder are especially heightened during the transition from prisons and jails; 52% of all overdose mortality in Connecticut occurred in recently released prisoners. Treating opioid use disorder in prisoners and maintaining after release from prison is one of the most effective strategies to address the negative consequences of the opioid epidemic. For prisoners with opioid use disorder, however, they are often overly-optimistic that they no longer need treatment or have insufficient information to guide their selection of available treatments. Decision aids are evidence-based strategies to more effectively engage patients (and providers) in their treatment. Decision aids for other conditions and settings have been shown to improve knowledge and opting for choices that better comport with patient values and preferences, thus increasing likelihood of initiation and retention in evidence-based care. The candidate plans to adapt a decision aid that she developed for community treatment settings to the transitional period from incarceration. This aid is designed to improve both patient and provider knowledge and attitudes, to overcome misinformation and negative feelings about treatment. To adapt the current decision aid for opioid use disorder (OUD) treatment, the candidate proposes to conduct mixed- methods assessments of both incarcerated individuals with OUD and multidisciplinary justice system staff, regarding shared decision making for OUD treatment and medication initiation prior to release. Informed by these results, she will adapt (using a systematic framework) an existing tablet-based decision aid for OUD treatment with usability/field testing. This finalized and new decision aid for incarcerated individuals anticipating release will be piloted to assess feasibility and acceptability among the incarcerated individuals and staff, as well as for feasibility of the trial and preliminary effectiveness for increasing medication initiation compared to counseling as usual. These proposed aims will be supported with a plan of mentorship and training, all of which will support the candidate’s ultimate development into an independent researcher with an eventual R01 submission in patient-centered research in substance use and infectious disease.