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Informed and patient-centered decision-making in the primary care visits of African Americans with depression.

Abstract：

OBJECTIVE:We examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression. METHODS:We performed a cross-sectional analysis of audiotaped clinical encounters and post-visit surveys of 76 patients and their clinicians. We used RIAS to characterize patient-centeredness of visit dialogue. IDM entailed discussion of 3 components: the nature of the decision, alternatives, and pros/cons. PCDM entailed discussion of: lifestyle/coping strategies, knowledge/beliefs, or treatment concerns. We examined the association of IDM and PCDM with visit duration, overall patient-centeredness, and patient/clinician interpersonal ratings. RESULTS:Approximately one-quarter of medication and counseling decisions included essential IDM elements and 40% included at least one PCDM element. In high patient-centered visits, IDM was associated with patients feeling respected in counseling and liking clinicians in medication decisions. IDM was not related to clinician ratings. In low patient-centered visits, PCDM in counseling decisions was positively associated with patients feeling respected and clinicians respecting patients. CONCLUSIONS:The associations between IDM and PCDM with interpersonal ratings was moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues. PRACTICE IMPLICATIONS:Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making.

journal_name

Patient Educ Couns

journal_title

Patient education and counseling

authors

Hines AL,Roter D,Ghods Dinoso BK,Carson KA,Daumit GL,Cooper LA

doi

10.1016/j.pec.2017.07.027

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

233-240

issue

2

eissn

0738-3991

issn

1873-5134

pii

S0738-3991(17)30466-4

journal_volume

101

pub_type

杂志文章

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