Development of a Provider-Focused Intervention to Improve Health Outcomes in Pediatric Sickle Cell Disease

PROJECT SUMMARY/ABSTRACT This Mentored Patient-Oriented Research Career Development application (K23) will provide protected time for Dr. Siddika Mulchan to develop a focused program of research investigating aspects of care affecting health outcomes in youth with sickle cell disease (SCD). The aims of this 5-year career development plan are complementary and will increase Dr. Mulchan's knowledge and skills in: 1) mixed methods research design and analyses, 2) intervention development and refinement specifically targeting health outcomes in youth with SCD, 3) behavioral health clinical trials, and 4) clinical trials data analysis. The career development plan includes frequent structured meetings with mentors and consultants, coursework and workshop attendance, fellowship participation, and dissemination of research findings at conferences and publications. Research activities during the K23 award include writing literature reviews (e.g., manuscript on provider communication and health outcomes in pediatric SCD) and conducting the K23 research study (e.g., manuscripts on qualitative findings from focus group data, use of virtual patient technology to enhance provider communication, and efficacy-testing of the proposed intervention). Findings will be disseminated in 5 manuscripts submitted to peer-reviewed journals and conferences. The K23 study is a randomized clinical trial that will test the preliminary efficacy of a communication-enhancement intervention for health care providers (HCPs) in an outpatient setting to improve health outcomes in pediatric SCD. Two cognitive strategies that may improve patient-provider communication are individuation and perspective-taking (IPT). We piloted an IPT intervention with pediatric HCPs, and it was found to be feasible and acceptable. However, we need to refine the intervention and test its preliminary efficacy in improving patient-centered communication. Study aims are consistent with the NIH Stage Model for Behavioral Intervention Development and include a refinement phase, training phase, and testing phase. Specific aims are to: 1) refine IPT by examining perspectives of adolescents (ages 12-17 years) with SCD and their caregivers (parent or legal guardian) regarding HCP communication using mixed methods, 2) promote the uptake of communication skills with the refined IPT in a sample of HCPs using a pretest-posttest design with virtual patients, and 3) test the preliminary efficacy of the IPT intervention on improving patient-centered communication in a multi-center sample of pediatric SCD HCPs using a randomized design. Dr. Mark Litt is the primary mentor on this K23 application and has nationally and internationally recognized expertise in areas relevant to the specific aims of this application (e.g., mixed methods design and methodology, behavioral health clinical trials, clinical trials data analysis). Drs. William Zempsky and Adam Hirsh will serve as co-mentors and Drs. Javeed Sukhera, Paula Tanabe, and Michael Brimacombe as other significant contributors supporting and advising the candidate in selected areas (e.g., intervention development, behavioral health clinical trials, SCD clinical trials, and statistical analyses).