Racial Differences in Patient-provider Communication, Patient Self-efficacy, and Their Associations With Systemic Lupus Erythematosus-related Damage: A Cross-sectional Survey.
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2021-07
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Objective
Despite significant racial disparities in systemic lupus erythematosus (SLE) outcomes, few studies have examined how disparities may be perpetuated in clinical encounters. We aimed to explore associations between areas of clinical encounters - patient-provider communication and patient self-efficacy - with SLE-related damage, in order to identify potential areas for intervention to reduce SLE outcome disparities.Methods
We collected cross-sectional data from a tertiary SLE clinic including patient-provider communication, general self-efficacy, self-efficacy for managing medications and treatments, patient-reported health status, and clinical information. We compared racial groups and used logistic regression to assess race-stratified association of patient-provider communication and patient self-efficacy with having SLE-related damage.Results
Among 121 patients (37% White, 63% African American), African Americans were younger, more likely to be on Medicaid, and less likely to be college educated, married, or living with a partner or spouse. African Americans reported less fatigue and better social function, took more complex SLE medication regimens, had lower fibromyalgia (FM) scores, and had higher SLE disease activity and SLE-related damage scores. African Americans reported similar self-efficacy compared to White patients, but they reported more hurried communication with providers, which was reflected in their perception that providers used words that were difficult to understand. Perceiving providers use difficult words and lower general self-efficacy were associated with having SLE-related damage among African American but not White patients.Conclusion
African Americans had more severe SLE and perceived more hurried communication with providers. Both worse communication and lower self-efficacy were associated with having SLE-related damage among African American but not White patients, suggesting that these factors should be investigated as potential interventions to reduce SLE racial disparities.Type
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Publication Info
Sun, Kai, Amanda M Eudy, Lisa G Criscione-Schreiber, Rebecca E Sadun, Jennifer L Rogers, Jayanth Doss, Amy L Corneli, Hayden B Bosworth, et al. (2021). Racial Differences in Patient-provider Communication, Patient Self-efficacy, and Their Associations With Systemic Lupus Erythematosus-related Damage: A Cross-sectional Survey. The Journal of rheumatology, 48(7). pp. 1022–1028. 10.3899/jrheum.200682 Retrieved from https://hdl.handle.net/10161/28697.
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Scholars@Duke
Amanda Marie Eudy
Rebecca Eli Sadun
I am an adult and pediatric rheumatologist with clinical and research interests in the areas of lupus and transition to adult care. My time is split between the departments of Medicine and Pediatrics. In addition to seeing patients in both environments, I run a dedicated Young Adult Rheumatology Clinic in collaboration with Duke Family Medicine.
Amy Lynn Corneli
Dr. Amy Corneli, a social scientist by training, conducts qualitative, mixed-method, intervention, and implementation science research. Her work spans the U.S. and multiple countries in sub-Saharan Africa, the Middle East, and South and Southeast Asia. She has a history of collaborating with and learning from community organizations and representatives in conducting research with populations that face discrimination, bias, or unequal treatment within the healthcare system and society due to race, ethnicity, gender, sexual orientation, or socioeconomic status. Her collaborative research often focuses on generating synergies between the creativity of art and the analytical thinking of science. The findings from her research inform clinical trials and practice, socio-behavioral interventions, guideline development, and the practical dissemination of proven interventions.
Dr. Corneli's current research portfolio encompasses three areas:
- Leading, co-leading, mentoring, and supporting qualitative, mixed-methods, and implementation science research in HIV prevention.
- Serving as a methodological investigative partner on qualitative, mixed-methods, and intervention research on a variety of health conditions and topics with faculty in the School of Medicine at Duke University.
- Leading the social science team for the Clinical Trials Transformation Initiative, a public-private initiative between Duke University and the U.S. Food and Drug Administration.
Dr. Corneli is also the:
- Founder and Director of QualCore, a group of PhD- and master-level social scientists who partner with Duke faculty to provide scientific direction and interviewing and analysis expertise in qualitative research.
- Co-founder and Director of The BASE (Bioethics and Stakeholder Engagement) Lab, a group of faculty and staff that partner with clinical investigators at Duke to conduct research with key contributors to inform the planning, conduct, interpretation, and reporting of clinical research.
- Director of the Duke CFAR Social and Behavioral Sciences Core.
QualCore | https://populationhealth.duke.edu/research/qualcore
The BASE Lab | https://populationhealth.duke.edu/research/base-lab
Duke CFAR Social and Behavioral Sciences Core | https://cfar.duke.edu
Clinical Trials Transformation Initiative | https://www.ctti-clinicaltrials.org
Prior to joining Duke University, Dr. Corneli was engaged in biomedical HIV prevention research at FHI 360 for 10 years.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Megan Elizabeth Bowles Clowse
Dr. Megan Clowse is an Associate Professor of Medicine and Chief of the Division of Rheumatology and Immunology; she also holds joint appointments in the Department of Obstetrics and Gynecology and Population Health Sciences. Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 1000 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository. She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020. Dr. Clowse created www.LupusPregnancy.org and www.ReproRheum.Duke.edu, websites dedicated to improving pregnancy planning and management for patients and rheumatologists.
Dr. Clowse was the founding director of the Duke Lupus Clinic, where she continues to see patients each week and mentor junior faculty researchers. The team has developed a new approach to lupus classification and management and is currently collecting and analyzing patient- and physician-reported measures to better clarify this construct.
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