Group‐randomized trial of tailored brief shared decision‐making to improve asthma control in urban black adults

Abstract

Aims To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision‐making intervention and evaluate feasibility and acceptability of intervention procedures. Design Group‐randomized longitudinal pilot study. Methods In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE (N = 40) to a dose‐matched attention control intervention (N = 40). BREATHE is a one‐time shared decision‐making intervention delivered by clinicians during routine office visits. Ten clinicians were randomized and trained on BREATHE or the control condition. Participants were followed monthly for 3 months post‐intervention. Data were collected from December 2017 – May 2019 and included surveys, lung function tests, and interviews. Results Participants were Black/multiracial (100%) mostly female (83%) adults (mean age 45). BREATHE clinicians delivered BREATHE to all 40 participants with fidelity based on expert review of audiorecordings. While the control group reported improvements in asthma control at 1‐month and 3‐month follow‐up, only BREATHE participants had better asthma control at each timepoint (β = 0.77; standard error (SE)[0.17]; p ≤ 0.0001; β = 0.71; SE[0.16]; p ≤ 0.0001; β = 0.54; SE[0.15]; p = .0004), exceeding the minimally important difference. BREATHE participants also perceived greater shared decision‐making occurred during the intervention visit (β = 7.39; SE[3.51]; p = .03) and fewer symptoms at follow‐up (e.g., fewer nights woken, less shortness of breath and less severity of symptoms) than the controls. Both groups reported improved adherence and fewer erroneous medication beliefs. Conclusion BREATHE is a promising brief tailored intervention that can be integrated into office visits using clinicians as interventionists. Thus, BREATHE offers a pragmatic approach to improving asthma outcomes and shared decision‐making in a health disparity population. Impact The study addressed the important problem of uncontrolled asthma in a high‐risk vulnerable population. Compared with the dose‐matched attention control condition, participants receiving the novel brief tailored shared decision‐making intervention had significant improvements in asthma outcomes and greater perceived engagement in shared decision‐making. Brief interventions integrated into office visits and delivered by clinicians may offer a pragmatic approach to narrowing health disparity gaps. Future studies where other team members (e.g., office nurses, social workers) are trained in shared decision‐making may address important implementation science challenges as it relates to adoption, maintenance, and dissemination. Trail registration clinicaltrials.gov # NCT03300752.

Suboptimal Control of Asthma Among Diverse Patients: A US Mixed Methods Focus Group Study

“…In shared decision making, the patient or caregiver and the clinician discuss treatment options and their risks and benefits as well as the patient’s preferences, values, and lifestyle, with the aim of agreeing on a treatment that is best adapted to the patient while achieving their treatment goals. 23 Improved communication and shared decision making between health care professionals and patients with asthma or their caregivers has been shown to improve asthma control in a cross-sectional survey, 28 literature reviews, 29 , 30 a focus group study, 31 a group-randomized trial of a shared decision-making intervention, 32 and a cross-sectional analysis of audio-recorded medical consultations. 33 However, further investigation is needed because the results of the few randomized controlled studies performed so far have been mixed.…”

“…For example, in a randomized clinical trial using BREATHE (BRief intervention to Evaluate Asthma THErapy), a shared decision making intervention, participants included in shared decision making with their physician had better asthma control and reduced symptoms at follow-up compared to participants who received a control intervention. 32 Additionally, asthma control could be improved if health care professionals clearly communicate to patients the benefits of pairing ICS with a fast-acting bronchodilator for rescue treatment, as recommended in the newest treatment guidelines. 2 These guidelines should be discussed during shared decision making, which should take into account treatment efficacy and patient preferences.…”

Torn between two lovers – on being a psychologist in a university medical centre

“…As such, shared decision-making (SDM), as the concept suggests, is an attempt to incorporate the patient’s views into decisions about the medical management of a complaint, symptom, or disease. It is ‘a patient engagement model that includes strategies that promote patient and clinician engagement to jointly consider management options … the clinician’s role is to facilitate discussion of the risks and merits associated with options, the goal of reconciling differences.’ (George et al, 2021 , p. 1502).…”

Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis

“…The selected studies reported on a broad variety of conditions: oncology [33,35,45,47,49,[64][65][66]69,86,90,91], musculoskeletal disorders [34,40,42,44,48,50,55,81,84,87], cardiovascular disease [36,[51][52][53]70,78,93,94], general practice consultations [68,71,73,75,80,83,95], mental disorders [32,39,41,60,61,82], diabetes mellitus type II [37,43,46], elective otolaryngologic surgery [72,88,92], asthma [57,…”