- Primary Investigator:
Lisa A. Cooper - Primary Location:
Johns Hopkins School of Medicine - Grant Type & Year:
IIG 2007
Purpose
Specific aim 1: Describe the prevalence and extent of shared decision making (SDM) communication related to depression in primary care patients using audiotapes of patient enrollment visits.
Specific aim 2: Evaluate the construct and concurrent validity of this new measure of SDM communication.
Specific aim 3: Explore whether SDM communication at baseline predicts better processes and outcomes of care over 12 months of follow up.
This study will increase understanding of the role of SDM in improving outcomes for patients with depression and in reducing racial disparities in mental health care.
Findings
This study shows that the prevalence and extent of shared decision-making communication about depression among African American patients and their primary care clinicians is low and often excludes patient-centered features. In counseling decisions, SDM was linked to provider’s ratings of patient trust, feeling liked by the patient and time well spent, while patient-centered elements in these same decisions were linked to shorter visit duration and higher patient trust. In contrast, in medication decisions, SDM was associated with longer visit duration, while patient-centered elements were negatively associated with patients trusting providers. Inadequate shared decision-making communication may partially explain the lower observed rates of appropriate treatment and functional recovery among African American primary care patients with depression.
Although this study is limited, further inquiry into the dynamics of patient-clinician discussion could prove useful in developing interventions to improve communication and patient and clinician ratings of care for depression. Understanding the socio-cultural underpinnings of these interactions may also aid in the design of broader cultural competence training for mental healthcare providers as a strategy to enhance patient-clinician understanding and agreement with regard to treatment of depression.
