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Freytag J, Jiang ZJ, Giordano TP, Westbrook RA, McCurdy SA, Njue-Marendes S, Dang BN. What patient involvement means to new patients at two HIV clinics: A longitudinal, qualitative study. PATIENT EDUCATION AND COUNSELING 2019; 102:1535-1540. [PMID: 30948202 PMCID: PMC6565493 DOI: 10.1016/j.pec.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study 1) defines patient involvement from the perspective of patients new to a provider, 2) describes provider communication that patients perceive as promoting involvement, and 3) examines changes in patient definitions of involvement over time. METHODS We enrolled 56 patients at two HIV clinics in Houston, Texas, from August 2013 until March 2015. We interviewed patients three times during the first year of care and analyzed interviews using content analysis. RESULTS The mean age was 45 years; 54% were men. Patient definitions of involvement ranged from adherence- to decision-oriented. Analysis revealed three provider communication behaviors that patients perceive as promoting involvement: 1) soliciting patient feedback, 2) discussing treatment options and trade-offs, 3) narrating the decision-making process. Definitions of involvement can change over time as providers reframe the patient's illness as manageable and through perceived partnerships with the provider. CONCLUSION Provider communication plays a critical role in shaping new patients' perception of involvement and can make patients feel involved even when patients do not actively make medical decisions. PRACTICAL IMPLICATIONS Finding strategies to make patients feel involved in their care is important, particularly for new patients, even if those strategies do not necessarily promote more talk from the patient.
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Affiliation(s)
- Jennifer Freytag
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Zhixin J Jiang
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Robert A Westbrook
- Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, United States.
| | - Sheryl A McCurdy
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
| | - Sarah Njue-Marendes
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Bich N Dang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
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Cottingham MD, Kalbaugh JM, Swezey T, Fisher JA. Exceptional Risk: Healthy Volunteers' Perceptions of HIV/AIDS Clinical Trials. J Acquir Immune Defic Syndr 2018; 79 Suppl 1:S30-S36. [PMID: 30222703 PMCID: PMC6373478 DOI: 10.1097/qai.0000000000001818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As with all early-stage testing of investigational drugs, clinical trials targeting HIV/AIDS can pose unknown risks to research subjects. Unlike sick participants seeking a therapeutic benefit, the motivations and barriers for healthy volunteers are more complex and understudied. Drawing on interviews and clinical trial data from 178 healthy volunteers, we examine how they perceive HIV/AIDS studies in the early stages of testing. A subset of healthy volunteers see phase I HIV/AIDS studies as particularly risky for reasons ranging from fear of catching the disease or having long-lasting and uncomfortable side effects to inexplicable fears that they cannot even articulate. Some participants have had past negative experiences in such trials that inform these views, but others cite information from staff and other participants as influential. Healthy volunteers' general fears concerning AIDS also shape their views of participating in phase I HIV/AIDS clinical trials.
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Affiliation(s)
| | - Julianne M. Kalbaugh
- Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Teresa Swezey
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Jill A. Fisher
- Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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