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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 26 Research Studies DisplayedKurasz AM, Smith GE, Curiel RE
Patient values in healthcare decision making among diverse older adults.
This study investigated the types of values that culturally diverse older adults incorporate in medical decision making. Focus groups were held with 49 individuals, 49% with mild cognitive impairment, and 51% Hispanic. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation. A wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own were expressed. Participants also emphasized that values are individual-specific, influenced by aging, and change throughout life.
AHRQ-funded; HS024159.
Citation: Kurasz AM, Smith GE, Curiel RE .
Patient values in healthcare decision making among diverse older adults.
Patient Educ Couns 2022 May;105(5):1115-22. doi: 10.1016/j.pec.2021.08.031..
Keywords: Elderly, Decision Making, Racial and Ethnic Minorities
Gaskin DJ, Karmarkar TD, Maurer A
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
This study examined whether using a decision-making tool would aid Latina and African-American women over age 45 years with arthritic knee pain in making more informed treatment decisions. The researchers conducted 4 focus groups of Latina and African-American women and 2 focus groups with primary care providers who treated them for knee pain. They found that minority women and primary care providers all endorsed the use of a decision-making tool that provided information on the impact of treatment on quality of life, medical care costs, and work productivity.
AHRQ-funded; HS000029.
Citation: Gaskin DJ, Karmarkar TD, Maurer A .
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
Arthritis Care Res 2020 May;72(5):692-98. doi: 10.1002/acr.23903..
Keywords: Arthritis, Orthopedics, Pain, Quality of Life, Healthcare Costs, Decision Making, Racial and Ethnic Minorities, Women
Acree ME, McNulty M, Blocker O
Shared decision-making around anal cancer screening among black bisexual and gay men in the USA.
This study focused on shared decision-making on anal cancer screening among black gay and bisexual men in the US. The researchers conducted 30 semi-structured one-on-one interviews and two focus groups in 2016-2017. Out of forty-five participants, all were black and male, with 13 identified as bisexual and 32 as gay. Barriers to screening include internalized racism, biphobia/homophobia, provider bias lead to reduced healthcare engagement and discomfort discussing sexual practices which hindered shared decision-making.
AHRQ-funded; HS023050.
Citation: Acree ME, McNulty M, Blocker O .
Shared decision-making around anal cancer screening among black bisexual and gay men in the USA.
Cult Health Sex 2020 Feb;22(2):201-16. doi: 10.1080/13691058.2019.1581897..
Keywords: Decision Making, Cancer, Screening, Prevention, Racial and Ethnic Minorities, Vulnerable Populations
Hale KL, Wallace DD, Blanco-Duran D
Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs.
The authors evaluated shared decision-making (SDM) and delineated SDM processes in audio-recorded conversations between language-congruent Spanish-/English-speaking clinicians and parents of pediatric mental health patients. They found that their present sample performed on par with other populations studied to date, and that it expanded the evaluation of observed SDM to include Latino patients and new clinician populations. The practical implications of their findings is that use of the Observer OPTION(5) instrument highlights that eliciting and integrating parent/patient preferences is a skill that requires attention when delivering culturally competent interventions.
AHRQ-funded; HS000032.
Citation: Hale KL, Wallace DD, Blanco-Duran D .
Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs.
Patient Educ Couns 2020 Jan;103(1):96-102. doi: 10.1016/j.pec.2019.08.013..
Keywords: Children/Adolescents, Decision Making, Cultural Competence, Racial and Ethnic Minorities, Clinician-Patient Communication, Communication, Caregiving, Behavioral Health
Bi S, Gunter KE, Lopez FY
Improving shared decision making for Asian American Pacific Islander sexual and gender minorities.
This study examined the challenges Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) encounter with shared decision making (SDM) with their providers, especially concerning mental health. Focus groups were conducted in San Francisco and interviews were conducted in Chicago and San Francisco. The participants were surveyed about attitudes towards SGM disclosure and preferences about providers. Many participants felt that providers either ignored or overemphasized their identities. Some shared the stigma of SGM identities and effects on mental health in their own families.
AHRQ-funded; HS023050.
Citation: Bi S, Gunter KE, Lopez FY .
Improving shared decision making for Asian American Pacific Islander sexual and gender minorities.
Med Care 2019 Dec;57(12):937-44. doi: 10.1097/mlr.0000000000001212..
Keywords: Decision Making, Racial and Ethnic Minorities, Vulnerable Populations, Patient and Family Engagement, Patient-Centered Healthcare, Behavioral Health, Social Stigma
Goff SL, Garb JL, Guhn-Knight H
Spatial analysis of factors influencing choice of paediatric practice for mothers from low-income and minority populations.
Publicly reported quality data theoretically enable parents to choose higher-performing paediatric practices. However, little is known about how parents decide where to seek paediatric care. In this study, the investigators explored the relationship between geographic factors, care quality and choice of practice to see if the decision-making process could be described in terms of a 'gravity model' of spatial data.
AHRQ-funded; HS021879.
Citation: Goff SL, Garb JL, Guhn-Knight H .
Spatial analysis of factors influencing choice of paediatric practice for mothers from low-income and minority populations.
J Paediatr Child Health 2019 Aug;55(8):948-55. doi: 10.1111/jpc.14322..
Keywords: Caregiving, Decision Making, Low-Income, Quality of Care, Racial and Ethnic Minorities
Gordon BE, Basak R, Carpenter WR
Factors influencing prostate cancer treatment decisions for African American and white men.
This prospective, population-based cohort study examined some possible reasons for mortality outcome differences for prostate cancer between African American (AA) and white patients. A cohort of 1170 men with nonmetastatic prostate cancer were enrolled from 2011 to 2013 before treatment in North Carolina. Participants were asked to rate their aggressiveness of their cancer, and also the importance of 10 factors their treatment decision-making process. Among low-risk patients, there was no difference in perception of their cancer as “not very aggressive”. Among high-risk patients, 54% of AA patients considered their cancer to be “not very aggressive” while only 24% of white patients did. For AA patients, cost, treatment time, and recovery time were considered very important more than white patients.
AHRQ-funded.
Citation: Gordon BE, Basak R, Carpenter WR .
Factors influencing prostate cancer treatment decisions for African American and white men.
Cancer 2019 May 15;125(10):1693-700. doi: 10.1002/cncr.31932..
Keywords: Decision Making, Cancer, Cancer: Prostate Cancer, Disparities, Men's Health, Outcomes, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Hong M, Casado BL, Lee SE
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
The authors examined the intention to discuss advance care planning (ACP) for a family member with Alzheimer's disease among Korean Americans. Path analyses were conducted on a cross-sectional convenience sample; age, gender, education, and knowledge about Alzheimer's disease and ACP were included as covariates. From their findings, the authors recommended promoting ACP among this population and designing educational interventions to address positive attitudes and subjective norms toward ACP.
AHRQ-funded; HS022947.
Citation: Hong M, Casado BL, Lee SE .
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
Gerontologist 2019 Mar 14;59(2):347-55. doi: 10.1093/geront/gnx211..
Keywords: Elderly, Dementia, Neurological Disorders, Decision Making, Racial and Ethnic Minorities
Shorten A, Shorten B, Fagerlin A
A study to assess the feasibility of implementing a web-based decision aid for birth after cesarean to increase opportunities for shared decision making in ethnically diverse settings.
This article describes a study that tested the feasibility and acceptability of implementing a Health Insurance Portability and Accountability Act-secure, Web-based decision aid tool that supports shared decisionmaking with regard to birth choices after cesarean in urban, ethnically diverse outpatient settings. Sixty-eight women participated in the study; the measures included the women's knowledge, decisional conflict, birth preferences and outcomes, decision aid use and acceptability ratings, and views on how the decision aid supported shared decisionmaking. The women rated the content, features, and functions as good or excellent. Most indicated they would recommend it to others. The researchers conclude that while the decision aid is feasible, strategies are needed to improve women's access and to encourage timely decision aid usage to prepare them for decision discussions with health care providers.
AHRQ-funded; HS022114.
Citation: Shorten A, Shorten B, Fagerlin A .
A study to assess the feasibility of implementing a web-based decision aid for birth after cesarean to increase opportunities for shared decision making in ethnically diverse settings.
J Midwifery Womens Health 2019 Jan;64(1):78-87. doi: 10.1111/jmwh.12908..
Keywords: Decision Making, Education: Patient and Caregiver, Health Information Technology (HIT), Pregnancy, Racial and Ethnic Minorities, Web-Based, Women
Breathett K, Jones J, Lum HD
Factors related to physician clinical decision-making for African-American and Hispanic patients: a qualitative meta-synthesis.
The purpose of this study was to synthesize qualitative studies that explore various aspects of how patients’ African-American race or Hispanic ethnicity may factor into physician clinical decision-making. Researchers derived six fundamental themes that detail the role of patient race and ethnicity on physician decision-making. They found that a non-hierarchical system of intertwining themes influenced clinical decision-making among racial and ethnic minority patients and recommended paths for future study.
AHRQ-funded; HS024569.
Citation: Breathett K, Jones J, Lum HD .
Factors related to physician clinical decision-making for African-American and Hispanic patients: a qualitative meta-synthesis.
J Racial Ethn Health Disparities 2018 Dec;5(6):1215-29. doi: 10.1007/s40615-018-0468-z..
Keywords: Racial and Ethnic Minorities, Decision Making, Disparities
Harris VC, Links AR, Walsh J
A systematic review of race/ethnicity and parental treatment decision-making.
Researchers examined patient race/ethnicity as it affects health care utilization, provider trust, and treatment choice in pediatric care. Pooled results from their systematic review showed (1) racial/ethnic minorities tended to prefer more aggressive end-of-life care; (2) familial tradition of neonatal circumcision influenced the decision to circumcise; and (3) non-Hispanic Whites were less likely to pursue human papillomavirus vaccination but more likely to complete the vaccine series if initiated. They recommended further investigation.
AHRQ-funded; HS022932.
Citation: Harris VC, Links AR, Walsh J .
A systematic review of race/ethnicity and parental treatment decision-making.
Clin Pediatr 2018 Oct;57(12):1453-64. doi: 10.1177/0009922818788307..
Keywords: Children/Adolescents, Decision Making, Caregiving, Racial and Ethnic Minorities, Healthcare Utilization
Jolles MP, Lee PJ, Javier JR
Shared decision-making and parental experiences with health services to meet their child's special health care needs: racial and ethnic disparities.
This study investigated the relationship between shared decision-making (SDM) and parents’ frustrations in getting health needs met for their special needs child. Secondary analysis was done on data from the 2009-2010 National Survey of Children with Special Health Care Needs. More Whites than Blacks engaged in SDM, and when Blacks did engage they had a higher odds of negative experiences than Whites. Researchers weren’t sure what the cause was of that, but speculated it was due to increased awareness of service challenges.
AHRQ-funded; HS000032.
Citation: Jolles MP, Lee PJ, Javier JR .
Shared decision-making and parental experiences with health services to meet their child's special health care needs: racial and ethnic disparities.
Patient Educ Couns 2018 Oct;101(10):1753-60. doi: 10.1016/j.pec.2018.05.022..
Keywords: Access to Care, Caregiving, Children/Adolescents, Decision Making, Disabilities, Disparities, Racial and Ethnic Minorities
Calabrese SK, Earnshaw VA, Krakower DS
A closer look at racism and heterosexism in medical students' clinical decision-making related to HIV pre-exposure prophylaxis (PrEP): implications for PrEP education.
In this survey study of 115 US medical students, researchers examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. They concluded that prior PrEP education did not buffer any indirect effects. Also, heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.
AHRQ-funded; HS022986.
Citation: Calabrese SK, Earnshaw VA, Krakower DS .
A closer look at racism and heterosexism in medical students' clinical decision-making related to HIV pre-exposure prophylaxis (PrEP): implications for PrEP education.
AIDS Behav 2018 Apr;22(4):1122-38. doi: 10.1007/s10461-017-1979-z.
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Keywords: Decision Making, Education: Academic, Human Immunodeficiency Virus (HIV), Prevention, Racial and Ethnic Minorities
Hines AL, Roter D, Ghods Dinoso BK
Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
This study 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. It concluded that the associations between IDM and PCDM with interpersonal ratings were moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues. Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making.
AHRQ-funded; HS013645.
Citation: Hines AL, Roter D, Ghods Dinoso BK .
Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
Patient Educ Couns 2018 Feb;101(2):233-40. doi: 10.1016/j.pec.2017.07.027.
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Keywords: Decision Making, Depression, Patient-Centered Healthcare, Primary Care, Racial and Ethnic Minorities
Magnusson DM, Minkovitz CS, Kuhlthau KA
AHRQ Author: Mistry KB
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
This study sought to understand the role of health beliefs in shaping maternal decisions regarding help-seeking for children with developmental delay (DD) and explore differences between African American and Hispanic mothers. Five major themes emerged describing the role of maternal health beliefs in shaping key stages of the help-seeking pathway for children with DD. Differences between African American and Hispanic mothers are also described.
AHRQ-authored.
Citation: Magnusson DM, Minkovitz CS, Kuhlthau KA .
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
Pediatrics 2017 Nov;140(5):pii: e20172059. doi: 10.1542/peds.2017-2059.
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Keywords: Children/Adolescents, Decision Making, Disabilities, Low-Income, Racial and Ethnic Minorities
Davis CM, Guo M, Miyamura J
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Understanding (1) how expectant mothers gather information to decide where to give birth, and (2) who helps make that decision, provides critical health communication and decision-making insights. This survey found that the top three health decision-makers for both those Asian American and Pacific Islanders (AAPIs) with limited English proficiency and English-proficient AAPIs were themselves, their obstetrician, and their spouse, which did not differ significantly by language proficiency.
AHRQ-funded; HS021903.
Citation: Davis CM, Guo M, Miyamura J .
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Hawaii J Med Public Health 2017 Oct;76(10):279-86.
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Keywords: Healthcare Delivery, Cultural Competence, Decision Making, Pregnancy, Racial and Ethnic Minorities
Hoffman AS, Lowenstein LM, Kamath GR
An entertainment-education colorectal cancer screening decision aid for African American patients: a randomized controlled trial.
The purpose of this study was to assess whether an entertainment-education decision aid tailored for African American patients improved patients' decision making, attitudes, intentions, or colorectal cancer screening behavior. It found that viewing the culturally tailored decision aid significantly increased African American patients' knowledge of colorectal cancer screening recommendations and options. It also significantly reduced their decisional conflict and improved their self-advocacy.
AHRQ-funded; HS022134.
Citation: Hoffman AS, Lowenstein LM, Kamath GR .
An entertainment-education colorectal cancer screening decision aid for African American patients: a randomized controlled trial.
Cancer 2017 Apr 15;123(8):1401-08. doi: 10.1002/cncr.30489.
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Keywords: Cancer: Colorectal Cancer, Decision Making, Education: Patient and Caregiver, Racial and Ethnic Minorities, Screening
Tan JY, Xu LJ, Lopez FY
Shared decision making among clinicians and Asian American and Pacific Islander sexual and gender minorities: an intersectional approach to address a critical care gap.
The authors illustrated how issues at the intersection of Asian American and Pacific Islander (AAPI) and sexual and gender minorities (SGM) identities affect shared decision making processes and health outcomes. They discussed experiences of AAPI SGM that are affected by AAPI heterogeneity, SGM stigma, multiple minority group identities, and sources of discrimination.
AHRQ-funded; HS022433.
Citation: Tan JY, Xu LJ, Lopez FY .
Shared decision making among clinicians and Asian American and Pacific Islander sexual and gender minorities: an intersectional approach to address a critical care gap.
LGBT Health 2016 Oct;3(5):327-34. doi: 10.1089/lgbt.2015.0143.
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Keywords: Decision Making, Disparities, Racial and Ethnic Minorities, Clinician-Patient Communication, Social Stigma
DeMeester RH, Lopez FY, Moore JE
A model of organizational context and shared decision making: application to LGBT racial and ethnic minority patients.
The authors propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support shared decisionmaking (SDM). Their model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. They provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations.
AHRQ-funded; HS023050.
Citation: DeMeester RH, Lopez FY, Moore JE .
A model of organizational context and shared decision making: application to LGBT racial and ethnic minority patients.
J Gen Intern Med 2016 Jun;31(6):651-62. doi: 10.1007/s11606-016-3608-3.
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Keywords: Decision Making, Racial and Ethnic Minorities, Racial and Ethnic Minorities
Peek ME, Lopez FY, Williams HS
Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians.
The purpose of this review was to understand how race, sexual orientation and gender identity can simultaneously influence shared decision making (SDM) among African-American LGBT persons. It also presents a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making.
AHRQ-funded; HS023050.
Citation: Peek ME, Lopez FY, Williams HS .
Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians.
J Gen Intern Med 2016 Jun;31(6):677-87. doi: 10.1007/s11606-016-3616-3.
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Keywords: Decision Making, Social Determinants of Health, Racial and Ethnic Minorities, Patient-Centered Outcomes Research
Chin MH, Lopez FY, Nathan AG
Improving shared decision making with LGBT racial and ethnic minority patients.
In 2014, the authors' team at the University of Chicago, supported by funds from AHRQ and the Patient-Centered Outcomes Research Trust Fund, began examining how to reduce disparities for LGBT racial/ethnic minority patients through improved shared decisionmaking (SDM). Their three goals are to review what is known, to perform interviews and focus groups of patients and clinicians, and to develop tools and resources. The three articles in this issue’s JGIM symposium on "Improving Shared Decision Making with LGBT Racial and Ethnic Minority Patients" reflect their initial foundational work.
AHRQ-funded; HS023050.
Citation: Chin MH, Lopez FY, Nathan AG .
Improving shared decision making with LGBT racial and ethnic minority patients.
J Gen Intern Med 2016 Jun;31(6):591-3. doi: 10.1007/s11606-016-3607-4.
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Keywords: Decision Making, Disparities, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Nathan AG, Marshall IM, Cooper JM
Use of decision aids with minority patients: a systematic review.
The authors conducted a systematic review to characterize the application and effectiveness of decision aids (DA) in racial, ethnic, sexual, and gender minorities. ical decisions. They concluded that DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities.
AHRQ-funded; HS023050.
Citation: Nathan AG, Marshall IM, Cooper JM .
Use of decision aids with minority patients: a systematic review.
J Gen Intern Med 2016 Jun;31(6):663-76. doi: 10.1007/s11606-016-3609-2.
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Keywords: Decision Making, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Clinician-Patient Communication
Lee SC, Marks EG, Sanders JM
Elucidating patient-perceived role in "decision-making" among African Americans receiving lung cancer care through a county safety-net system.
The researchers explored patient-perceived role in "decision-making" related to active treatment and palliation among African Americans receiving lung cancer care through a county safety-net system. They found that caregivers and patients expressed a concurrent lack of understanding of their prognosis and outcomes of treatment. Dyads did not discuss their lung cancer experience in terms of decision-making; rather, most articulated their role as following physician guidance.
AHRQ-funded; HS022418.
Citation: Lee SC, Marks EG, Sanders JM .
Elucidating patient-perceived role in "decision-making" among African Americans receiving lung cancer care through a county safety-net system.
J Cancer Surviv 2016 Feb;10(1):153-63. doi: 10.1007/s11764-015-0461-z.
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Keywords: Cancer: Lung Cancer, Cancer, Racial and Ethnic Minorities, Decision Making, Clinician-Patient Communication
Chen J, Mullins CD, Novak P
Personalized strategies to activate and empower patients in health care and reduce health disparities.
The authors proposed a patient-centered, multilevel activation and empowerment framework to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. They believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.
AHRQ-funded; HS022135.
Citation: Chen J, Mullins CD, Novak P .
Personalized strategies to activate and empower patients in health care and reduce health disparities.
Health Educ Behav 2016 Feb;43(1):25-34. doi: 10.1177/1090198115579415.
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Keywords: Decision Making, Disparities, Patient and Family Engagement, Patient-Centered Healthcare, Racial and Ethnic Minorities
Roberts MC, Weinberger M, Dusetzina SB
Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing.
The researchers examined whether adjuvant chemotherapy initiation varied by race. No racial differences were found in adjuvant chemotherapy initiation among women receiving ODX testing. As treatment decision-making becomes increasingly targeted with the use of genetic technologies, these results provide evidence that test results may drive treatment in a similar way across racial subgroups.
AHRQ-funded; HS022189.
Citation: Roberts MC, Weinberger M, Dusetzina SB .
Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing.
Breast Cancer Res Treat 2015 Aug;153(1):191-200. doi: 10.1007/s10549-015-3518-9..
Keywords: Cancer: Breast Cancer, Treatments, Decision Making, Genetics, Racial and Ethnic Minorities