• Improving Adherence and Outcomes in Cystic Fibrosis via the Clinical Encounter

    Collaborations with PI Lisa Opipari-Arrigan

    Treatment nonadherence in pediatric chronic illness is prevalent and exacerbates morbidity and mortality. The clinical encounter has extraordinary potential as a context for adherence promotion with sustained effects; most outpatient care occurs within the encounter and pediatric patients interact with providers over a lifetime course of care. However, substantial impediments exist to realizing this potential: little research describes the clinical encounter in children with chronic conditions or its impact on adherence behaviors, and that which does relies on patient or provider reports, rather than analysis of observed behaviors.

    This study uses video observation and a multiple baseline design to evaluate the effects of specific physician behaviors on patients’ cognitions and adherence behaviors.

    Objectives

    The specific objectives are to

    1. Systematically enhance specific physician communication and shared decision making behaviors during the clinical encounter.
    2. Determine the extent to which these changes in physician behavior lead to changes in patient’s cognitions and adherence behaviors. 

    We are working with two physician and their patients in the CF Clinic. Eligible patients are aged 2-12 years and have a diagnosis of CF. We video record clinical encounters and code for specific relationship building, information exchange, and treatment planning behaviors. We then select and modify specific physician behaviors. We are using single subject methodology and a multiple baseline design to evaluate change in the physician and patient behaviors of interest. Outcome variables will include patients’ cognitions and adherence behaviors. This project will inform and improve the way that we deliver clinical care and directly benefit the experiences and outcomes of our patients.