Teens with asthma aren’t great at taking an active role during doctor visits. A team at the UNC Eshelman School of Pharmacy believes changing that is a matter of asking the right questions.
Working with a group of teens and parents, a research group led by Betsy Sleath, PhD, has developed a set of questions teens can use as prompts for discussing their asthma with their physician. Sleath has received a three-year, $1.9 million contract grant from the Patient-Centered Outcomes Research Institute to produce an educational video in English and Spanish that will encourage teens and parents to use the question prompt list to be more involved during their asthma visits. The team will assess the effectiveness of this approach to see if it improves communication and patient outcomes.
Be Quiet for a Moment
“We want to find ways to activate the teens and get the parents to be quieter,” Sleath says. “Teens don’t want to be different from their peers, and it’s not uncommon for them to be in denial about their asthma. They may stop taking their long-term control meds and rely only on quick-relief meds, which don’t keep asthma under control. This leads to problems.”
In previous studies, Sleath has found that only 13 percent of teens asked questions about asthma management during medical visits. And 78 percent of teens said they had at least one problem with their asthma medication yet only 11 percent brought those problems up during visits to the doctor.
Teens gave Sleath a number of reasons for remaining passive at the doctor’s office:
- “The doctor doesn’t stop talking. “
- “My parents ask the questions.”
- “I don’t remember what to ask.”
The goal of the PCORI-funded project is to make teens more effective at managing their asthma, which results in better control of their condition, fewer missed school days, and better quality of life, Sleath says.
The Plan
The team will use input from focus groups of physicians, parents, and teens to improve their question prompt list and to develop a short video that emphasizes the importance of engaging teens in meaningful conversation during doctor visits.
The team will then enroll 360 African American, Latino, and Caucasian children between the ages of eleven and seventeen in the study. Teens in the intervention group will watch the video developed by Sleath’s team before their doctor visit and will be given the list of questions so they can check which questions they want to ask. Those in the control group will receive their usual care. The medical visits will be audiotaped, and the team will interview each subject and measure lung function immediately after that first visit and six and twelve months thereafter.
The study will assess how well the participants are controlling their asthma and their quality of life. They will also document the number of questions teens ask during visits, whether providers include teen input in asthma-management decisions, teen satisfaction, medication adherence, and asthma-related health-care use.
PCORI
The Patient-Centered Outcomes Research Institute is an independent, nonprofit organization authorized by Congress in 2010 to fund comparative clinical effectiveness research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed health and health-care decisions. PCORI is committed to seeking input from a broad range of stakeholders to guide its work. It has approved $671 million to support 360 research studies and initiatives since it began funding research in 2012. For more information about PCORI funding, visit http://pcori.org.
The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract to the University of North Carolina at Chapel Hill.
The Research Team
- Betsy Sleath, PhD, is the George H. Cocolas Distinguished Professor at the UNC Eshelman School of Pharmacy and chair of the School’s Division of Pharmaceutical Outcomes and Policy. She is director of the Child and Adolescent Health Program at the Cecil G. Sheps Center for Health Services Research, as well as codirector of the Community Academic Resources for Engaged Scholarship core of the North Carolina Translational and Clinical Sciences Institute, home of the NIH Clinical and Translational Science Awards program at UNC.
- Ceila Loughlin, MD, UNC School of Medicine, pediatric pulmonologist
- Delesha Carpenter, MSPH, PhD, is an assistant professor in the UNC Eshelman School of Pharmacy’s Division of Pharmaceutical Outcomes and Policy.
- Darren DeWalt, MD, MPH, is an associate professor in the UNC School of Medicine’s Division of General Medicine.
- Larry Mann, MD, is a pediatrician with Jeffers, Mann, and Artman Pediatric and Adolescent Medicine, P.A.
- Charles Lee, MD, is founder and president of Polyglot Systems, Inc.
- Gail Tudor, PhD, is director of institutional research at Husson University
- The parents and teens advising Sleath’s group are Dana Etheridge, Karolyne Batey, LaRonda Holman, TaZhana Holman-Skinner, Cristina Duchesne, and Laura Rivera-Duchesne.