Ineffective communication between patients of racial and ethnic minority backgrounds and their providers is a significant contributor to healthcare disparities, including mental healthcare disparities. Minority patients across care settings consistently rate the quality of communication with their clinicians as poorer than White patients, and studies describe these interactions as marked by conflicts, perceptions of discrimination, clinicians' dominance, and exclusion of patients in treatment decisions. This is problematic because suboptimal patient-provider communication has been linked to poorer health outcomes, lower patient satisfaction, and reduced patient-engagement. Despite efforts to improve patient-provider interactions, disparities in patient-provider communication persist among minority patients.
Moreover, lower levels of participation in shared decision-making (SDM) by minority patients is recognized as a significant contributor to racial and ethnic differences in patient-provider communication. Current efforts to improve patients' participation in SDM are limited by lack of understanding and integration of patients' social contexts in their treatment, and inadequate attention to precursors to SDM, such as patient engagement. While it is well established that effective communication is critical for patient-centered care and the reduction of healthcare disparities, few interventions have been developed and/or implemented to improve patient-provider communication among minority groups.
The study objectives are to adapt and pilot the George Washington University (GWU) patient navigation intervention, an evidence-based, healthcare disparity intervention in cancer care, to increase minority Veterans' participation in SDM (Aims 1 & 2). To facilitate intervention implementation in VA mental health settings, we will use system redesign methods to conduct pre-implementation planning (Aim 3). These study aims will be guided by an ecological approach to health communication and the Consolidated Framework for Implementation Research (CFIR).
Aim 1: We will elicit iterative feedback from various stakeholders at multiple VA facilities within VISN 10, in conjunction with an ethnographic study of Veterans and peers in mental health services, to adapt the GWU patient navigation intervention to be delivered by VA peer specialists to minority Veterans in mental healthcare. Aim 2: We will conduct a pilot RCT of the intervention developed in Aim 1 using a sample of (N=50) Veterans at one site to assess the intervention's effects on SDM and other patient level outcomes. We will also evaluate pre-implementation outcomes. Aim 3: Leveraging findings from Aims 1 & 2, we will use systems redesign methods to identify provider and systems-level barriers and facilitators to intervention implementation. We will examine clinical and operational processes, such as work flow, at two sites within VISN 10. This aim will identify practices that need to be modified or integrated into the intervention to ensure its effective implementation and sustainability.
Not yet available.
Findings from this study will contribute to the VA's efforts to improve patient-provider communication and reduce VA mental health care disparities. This study could affect the delivery of mental health care to minority Veterans in the VA.
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Mental, Cognitive and Behavioral Disorders
TRL - Applied/Translational