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Improving methods of incorporating racial/ethnic minority patients' treatment preferences into clinical care
Investigator (PI): Cook, Benjamin
Performing Organization (PO): (Current): Cambridge Health Alliance, Center for Multicultural Mental Health Research / (617) 806-8741
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2020
Record Source/Award ID: PCORI/ME-1507-31469
Funding: Total Award Amount: $1,059,782
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Past attempts at eliciting patient preferences have not taken into account the prior negative experiences of the patient and his or her family and community. This may lead minority patients to prefer different treatment options or no treatment at all. Eliciting preferences without sufficient context may result in treatment plans centered on incomplete preferences information. A mismatch between treatment and patient preferences worsens health outcomes via lower patient engagement, poorer adherence, and higher attrition. We propose to develop a new method that more accurately elicits patient preferences and to apply this method for depression and type II diabetes. The objectives are to leverage the power of a more thorough method that asks patients what matters in treatment and includes patient feedback about prior experiences, and to understand patient and provider perspectives on incorporating preferences questions into clinical care, and how this could help improve treatment plan setting and engagement in care. In aim 1, we develop and test a conceptual model of adaptive patient preferences for depression and type II diabetes. Our preferences elicitation procedure consists of conjoint analysis supplemented with additional survey questions to elicit individual, familial, community, and sociocultural factors that influence patient preferences. In aim 2, in-depth follow-up interviews with survey respondents explore themes generated from the survey. In aim 3, clinicians and health system stakeholders will discuss the results of the preferences elicitation procedure and the feasibility of adapting such procedures when co-developing a treatment plan for depression and diabetes. Understanding patient preferences for care is crucial to understanding and measuring racial/ethnic disparities in treatment for depression and type II diabetes, and is especially important when a clinician and patient jointly develop treatment plans. Stemming from our primary outcome (relative value of treatment options in dollars) and secondary outcome (negative prior patient experiences), our research will yield a patient-centered process for improving preferences elicitation, and guidelines for providers to incorporate additional questions about patient preferences into the joint development of a treatment plan. We will disseminate our methodology and results to facilitate replication for other diseases. Patients and health system stakeholders will be integrally involved in the research team to ensure that the perspective of a diverse community of stakeholders (patients, clinicians, and patient advocates) are incorporated from the onset of the grant period in all three research aims. Patients and providers are also the focus of qualitative interviews that further inform research methodology and results.
MeSH Terms:
  • Depression /complications
  • /*ethnology /*therapy
  • Diabetes Mellitus, Type 2 /complications
  • /*ethnology /*therapy
  • Feedback
  • Humans
  • * Minority Groups
  • Outcome Assessment, Health Care
  • Patient Participation
  • * Patient Preference
  • Patient-Centered Care
  • Social Class
Country: United States
State: Massachusetts
Zip Code: 02141
UI: 20163146
Project Status: Ongoing
Record History: ('2017: Project extended to 2020',)