Behavioral and Social Science Research on Understanding and Reducing Health Dispa

了解和减少健康障碍的行为和社会科学研究

• 批准号: 7936543
• 负责人: Said A Ibrahim
• 金额: $ 51.57万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-22 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7936543
• 关键词: African American; Attention; Attitude; Benefits and Risks; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Client satisfaction; Clinical; Communication; Control Groups; Counseling; Decision Aid; Decision Making; Degenerative polyarthritis; Disease Management; Educational Intervention; Foundations; Generations; Goals; Health; Intervention; Knee Osteoarthritis; Knee joint; Knowledge; Lead; Lower Extremity; Medical; Minority; Modeling; Operative Surgical Procedures; Orthopedic Surgery procedures; Orthopedics; Outcome; Patients; Pattern; Process; Publishing; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Replacement Arthroplasty; Reporting; Research; Research Design; Roter; Shapes; Societies; Staging; Surgeon; Systems Analysis; Techniques; Time; administrative database; base; behavioral/social science; design; disability; effective therapy; empowered; evidence base; expectation; improved; intervention effect; knee replacement arthroplasty; meetings; motivational enhancement therapy; patient oriented; preference; public health relevance; racial and ethnic disparities; social science research

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. PUBLIC HEALTH RELEVANCE: Numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of knee replacement, an effective and highly utilized treatment option for advanced knee osteoarthritis. This study will provide one of the first patient-centered interventions in the orthopedic setting designed to mitigate racial/ethnic disparity in access to joint replacement for patients who meet clinical indications for the treatment. The results of this study will not only inform the nation on strategies to reduce or eliminate one of most marked disparities in chronic disease management, but will also provide opportunities to improve quality of care for large segment of our society.

描述（由申请人提供）：许多研究证明了在骨关节炎（OA）管理联合替代时存在明显的种族/种族差异。非裔美国人（AA）比白人患者接受下肢OA联合替代的可能性低约40％，并且根据CDC的最新报告，这种差异正在持续。我们的研究小组发表了证据，表明与类似的白人患者相比，联合替代的AA候选者的关节替代偏好不同，并且这些差异主要是由于知识和对治疗风险/收益的知识差异和对手术结果的期望而造成的。此外，诸如关节替代的偏好敏感治疗的医生与医生交流是双向的，交流的内容和决策受患者的基准​​态度和偏好的影响以及他们参与讨论的能力。有初步的证据表明，对这种治疗的偏好，知识和期望的基线差异会影响AA患者与骨科医生之间的沟通质量，因此减少了AA患者接受关节替代建议的可能性。需要进行更多的研究来评估特定的干预措施，以帮助AA患者与骨科医生的沟通，并提高他们在临床表明时接受膝盖替代建议的可能性。我们提出一项随机对照试验是为了评估高质量，基于循证的，以患者为中心的教育干预措施，并补充了有关AA患者与骨科医生之间交流质量的有针对性咨询以及在临床指示时接受膝关节更换建议的可能性。 AA是潜在的膝关节置换术的患者，这些患者被转诊为骨科手术，将随机分配使用膝盖OA决策援助（DA）进行教育干预（DA），并补充了使用动机访谈（MI）技术或注意力控制治疗的简短咨询。我们将评估干预措施在干预后6个月内收到膝盖关节置换建议的可能性的影响。该提案的核心假设是，可以通过更好地告知患者在决策时提供的高质量，基于循证的，以患者为中心的循证，以患者为中心的教育干预措施来更好地告知患者，从而改善有关置换的骨科医生的沟通和决策。因此，该提案的主要特定目的是：1）检查干预措施对AA患者与骨科医生的沟通质量的影响，以及2）检查干预措施对临床表明时接受建议替换建议的可能性的影响。 公共卫生相关性：许多研究记录了膝关节置换的利用中存在明显的种族/种族差异，这是一种有效且高度利用的治疗选择，用于晚期膝关节骨关节炎。这项研究将在骨科环境中提供最早以患者为中心的干预措施之一，旨在减轻种族/族裔差异，以供符合治疗临床适应症的患者获得关节置换。这项研究的结果不仅将为国家提供减少或消除慢性疾病管理中最明显的差异之一的策略，而且还将为改善社会大部分地区的护理质量提供机会。