Notice Number: NOT-HS-16-010

Key Dates
Release Date:   March 23, 2016

Issued by
Agency for Healthcare Research and Quality (AHRQ)

Purpose

AHRQ supports research, evaluations, and demonstration projects concerning the delivery of health care in inner-city and rural areas (including frontier areas), and health care for priority populations.  Priority populations include low income groups; minority groups; women; children; the elderly; and individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care.  42 USC 299(c).  Investigators should review the document entitled, “AHRQ Policy on the Inclusion of Priority Populations,” which is available https://grants.nih.gov/grants/guide/notice-files/NOT-HS-03-010.html.

This Special Emphasis Notice (SEN) informs the research community that AHRQ intends to support research on  models of shared decision making (SDM) that are tailored  to the needs of low income and racial and ethnic minority patients.  While models of SDM in the general population are available, models of SDM for racial and ethnic minority populations are lacking.

SDM occurs when a clinician and patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available health care options, the clinician's knowledge and experience, and the patient's values and preferences (Source: http://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html.  Decision support tools, namely decision aids, are often used to facilitate the decision making process.

SDM is not only intended to impart knowledge—a necessary but insufficient initiator of behavior change—but also to engage the patient in the decision making process.  SDM also presents opportunities to address health literacy, cultural, language, access and trust issues that many racial and ethnic and low income groups experience, and can support the delivery of patient-centered care that is evidence-based.  For example, SDM can be used to facilitate the dissemination and uptake of PCOR findings.

AHRQ is interested in understanding how SDM can be used to promote informed decision making, to increase patient engagement, and to improve the quality of care among low income and racial and ethnic minority patients.  Examples of potential research include:

• Development and evaluation of new models of SDM or adaptations of existing models of SDM to meet the needs of low income and racial and ethnic minority populations. 
• Development and evaluation of tools that support SDM, facilitate participatory decision making; and/or combine information about effectiveness, safety and opportunity costs with the burden of treatment.
• Studies that provide an understanding of the patient’s perspective in SDM, and in the implementation and evaluation of SDM models in healthcare settings where low income and racial and ethnic minority populations seek care.
• Development and evaluation of interventions that increase patient and clinician awareness of biases that influence decision-making and that address barriers to effective patient-clinician communication.

Further Guidance
For the purposes of this notice, AHRQ encourages that a sufficient number of research study participants be comprised of low income, racial and ethnic minorities receiving healthcare in under resourced settings (i.e., safety net hospitals and ambulatory care facilities) to ensure meaningful findings for this population.

AHRQ will use standing research program announcements for the R01 (see https://grants.nih.gov/grants/guide/pa-files/PA-14-291.html), R03 (see  https://grants.nih.gov/grants/guide/pa-files/PA-15-147.html), and R18 (see  https://grants.nih.gov/grants/guide/pa-files/PA-14-290.html) funding mechanisms to support this research.

Inquiries

Please direct all inquiries to:

Marian James
Agency for Healthcare Research and Quality (AHRQ)
Center for Evidence and Practice Improvement
Telephone: 301-427-1609
Email: sdm@ahrq.hhs.gov