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A2726 - Developing a Brief Tailored Shared Decision-Making Intervention for African American Adults with Asthma: Results of a Qualitative Study to Identify Desired Intervention Features
Author Block: M. R. George1, A. Chung2, J. Bruzzese3; 1Columbia University School of Nursing, New York, NY, United States, 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, 3School of Nursing, Columbia University Medical Center, New York, NY, United States.
Rationale. African American adults experience worse asthma control compared to whites due, in part, to lower rates of inhaled corticosteroid (ICS) adherence. Shared decision-making (SDM), a patient-centered care model, improves asthma outcomes, including ICS adherence, when delivered over multiple sessions. Interventions comprised of multiple sessions are difficult to deliver and sustain in clinical settings. Yet, brief, tailored SDM interventions are lacking. To determine interest in a tailored SDM intervention in real-world settings we conducted focus groups (FG) with asthma patients and their friends/family at two federally qualified health centers (FQHCs) in Philadelphia. Methods. Patients (n=32) and friends/family (n=14) were recruited to one of six FGs (2 with patients, 2 with friends/family; 2 mixed). Patient inclusion criteria: African American (AA); >18 years old; prescribed ICS; and receives asthma care at that FQHC. Friends/family had to be >18 years old. Using conventional qualitative methods, an iterative semi-structured interview guide was used to direct discussions around what participants wanted at asthma visits. FGs were audio recorded and transcribed. Manifest and latent coding was done independently (MG) using qualitative descriptive content analysis approaches in which common codes were grouped into like categories. Categories were reviewed and discussed with another author (AC) until agreement about categories could be reached. Recruitment ended with data saturation (i.e., when no new information was learned). Results. Overall, 67% of the sample was female and 72% had the likelihood of marginal or limited health literacy as assessed by the Newest Vital Sign. Seventy-eight percent of patients had uncontrolled asthma as measured by the Asthma Control Questionnaire [ACQ]). Three salient categories were identified: 1) a desire for the patient/friend/family to be seen as an asthma expert in their own right with their treatment preferences given equal weight to the PCPs’ choices (SDM); 2) PCPs need patient-centered skills like communication, engagement, respect and courtesy; and 3) PCPs need to bluntly discuss risks (e.g., death) of suboptimal ICS use. Adherence could be improved through education, integration of test results (e.g., ACQs) into visits, focused discussions of ICS and increased contacts. Barriers to SDM included long-wait times, short visits and mistrust of PCPs. Conclusions. AA adults with asthma and their friends/family identified desired features of a tailored SDM intervention. These features were modifiable and were used to adapt a SDM intervention that will be delivered under real-world conditions (by PCPs at FQHCs at one visit) in an ongoing feasibility trial.