Does Shared Decision-Making Improve Adherence in Asthma
Condition: Lung Diseases; Asthma
MeSH terms: Asthma; Lung Diseases
Study type: Interventional

Summary: 
      To evaluate a model of shared decision-making for asthma treatment, appropriate to the needs
      of African American, Latino, Chinese, and other Asian and low income Caucasian patients to
      adherence to asthma controller medications in a two-year randomized clinical trial in 302
      minority and low-income adults, 18-70 years of age, with suboptimally controlled, persistent
      asthma, paralleling a simultaneous evaluation being conducted in 311 Caucasian and
      Asian/Pacific Island adults, (total n=613), and to examine psychological mechanisms mediating
      the effects of the intervention on adherence and of adherence on asthma outcomes.
    

Detailed description: 
      BACKGROUND:

      Asthma is a chronic inflammatory disorder of the airways. Despite major advances in
      understanding of its pathophysiology and management, asthma outcomes have not shown parallel
      improvement. Many patients with asthma are poorly controlled and have sub-optimal health
      status. Asthma care management by a trained non-physician health professional has developed
      as a means of addressing the problems of patients evidencing poor control and/or poor
      adherence to controller medications. Shared decision making (SDM) between clinician and
      patient has also been proposed as a means of getting greater patient involvement in their
      care, with the idea that this may improve medication adherence and outcomes. However,
      significant patient involvement also might result in less adequate regimens than would
      management based on guidelines (MBG). Even so, increased adherence to a less adequate regimen
      might result in better outcomes than poor adherence to an optimal regimen.

      DESIGN NARRATIVE:

      Better Outcomes of Asthma Treatment (BOAT) is a randomized controlled trial (a collaborative
      study designed to compare the effectiveness of three strategies for managing patients, 18-70
      years of age, with suboptimally controlled, persistent asthma. The three treatment strategies
      are: usual care (UC); management by guidelines (MG); and a third, shared decision making
      (SDM) arm, that seeks to formally involve the patient in the therapeutic decision-making
      process. Under the present grant, 302 study participants were recruited from the membership
      of the Kaiser Permanente - Northern California Region (KPNC), San Francisco, Oakland, and
      Richmond medical centers. In the collaborating grant (No.HL67092-03) 311 patients were
      recruited from Kaiser Permanente clinical facilities in Portland, OR, and Honolulu, HI.
      Patients were randomized equally to the three treatment arms following baseline assessment of
      asthma control, medication use, lung function, and other behavioral and psychological
      characteristics. Their health care utilization for asthma and acquisition of asthma
      medications is being followed for a total of 24 months post-randomization through health
      system records, and they are being reassessed at 12 mos. Those assigned to the care
      management conditions received asthma education and objective feedback on their level of
      asthma control. Those assigned to the MBG condition were prescribed a regimen appropriate to
      the severity of their asthma in accordance with standard guidelines for asthma management.
      Those assigned to the SDM condition participated in a process to elicit their goals for their
      asthma treatment and their priorities regarding their asthma medications, and then engaged in
      a process of shared decision making with the care manager designed to arrive at a prescribed
      regimen that satisfied their goals and preferences. Analysis of the data will compare the two
      care management approaches with usual care and with each other in terms of the primary
      outcomes.
    

Intervention name(s): Shared-Decision Making
Intervention type(s): Behavioral
Allocation: Randomized
Primary purpose: Treatment