Grant Number:	5P01HS010856-05 Interpret this number
Primary Investigator:	Washington, A
Organization:	University Of California-San Francisco
Project Title:	Promoting Effective Communication and Decision-Making Fo
Fiscal Year:	2004

The theme for this Program Project is Promoting Effective Communication and Decision-Making in Diverse Populations. Research proposed builds on our experience over the last decade conducting studies aimed at facilitating the reduction of racial and ethnic health disparities. This experience, along with findings from other research, has led us to believe that ineffective communication, resulting in suboptimal decision-making, is a core problem contributing substantially to the health gap observed today. Specifically, we hypothesize that racial/ethnic disparities in health may be attributable to less effective communication and decision-making in minority populations compared to their counterparts, leading to differences in technical processes of care that affect outcomes. In this Program Project we will I) identify elements of effective communication in diverse populations; 2) determine factors that enhance effective, patient-preference based, clinical decision-making (screening, diagnostic and treatment choices); 3) Evaluate methods for communicating risks (probability and outcomes) in diverse populations; 4) Lay foundation for developing decision-assisting tool(s) for coronary disease evaluation and treatment, and for cancer screening; and 5) Develop greater capacity for health services research, including a) expanding the pool of minority investigators focused on racial and ethnic minority populations, and b) improving methodologies for conducting research in diverse populations (scientific advancement). Findings from this Program Project will illuminate the elements of communication, expectations, values and interpersonal relationships that characterize the delivery and use of health care services for patients of different race/ethnicity, so that effective interventions may be devised. We will make these critical advances in the field by a) developing a more comprehensive specification of influences and variables hypothesized to explain disparities in health care and health; b) using a variety of complementary methodologies (primary data collection, secondary data analysis and direct observation) ; and c) employing multi-level approaches designed to capture the complexities of multiple pathways to health in diverse populations.




Willingness to use tamoxifen to prevent breast cancer among diverse women.
Authors: Kaplan CP, Kim SE, Wong ST, Sawaya GF, Walsh JM, Pérez-Stable EJ
Source: Breast Cancer Res Treat, 2012 May;133(1), p. 357-66.
PMID: 22315131
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Grant Numbers:

NCRR NIH HHS - UL1 RR024131	AHRQ HHS - 5P01 HS10856)	NIA NIH HHS - P30-AG15272

MeSH Terms:

Anticarcinogenic Agents	Regression Analysis	Educational Status
Humans	African Americans	Aged
Breast Neoplasms	Tamoxifen	Multivariate Analysis
Hispanic Americans	Patient Acceptance of Health Care	Risk Factors
European Continental Ancestry Group	Health Knowledge, Attitudes, Practice	Asian Americans
Middle Aged	Female

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Using visual displays to communicate risk of cancer to women from diverse race/ethnic backgrounds.
Authors: Wong ST, Pérez-Stable EJ, Kim SE, Gregorich SE, Sawaya GF, Walsh JM, Washington AE, Kaplan CP
Source: Patient Educ Couns, 2012 Jun;87(3), p. 327-35.
EPub date: 2012 Jan 12.
PMID: 22244322
Related Citations

Grant Numbers:

AHRQ HHS - 5P01 HS10856	NIA NIH HHS - P30 AG015272-15	NIA NIH HHS - P30-AG15272

MeSH Terms:

Humans	Cross-Cultural Comparison	Audiovisual Aids
Aged	Breast Neoplasms	Uterine Cervical Neoplasms
Risk	Mass Screening	Cross-Sectional Studies
Patient Acceptance of Health Care	Aged, 80 and over	Ethnic Groups
Health Knowledge, Attitudes, Practice	Health Behavior	Middle Aged
Colonic Neoplasms	Female	Decision Support Techniques

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Maternal and paternal race/ethnicity are both associated with gestational diabetes.
Authors: Caughey AB, Cheng YW, Stotland NE, Washington AE, Escobar GJ
Source: Am J Obstet Gynecol, 2010 Jun;202(6), p. 616.e1-5.
EPub date: 2010 Apr 18.
PMID: 20400060
Related Citations

Grant Numbers:

AHRQ HHS - 5 P01 HS10856-02

MeSH Terms:

Pedigree	Odds Ratio	Humans
Chi-Square Distribution	Cohort Studies	Retrospective Studies
Diabetes, Gestational	Male	Female
Pregnancy

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Measurement of social support across women from four ethnic groups: evidence of factorial invariance.
Authors: Wong ST, Nordstokke D, Gregorich S, Pérez-Stable EJ
Source: J Cross Cult Gerontol, 2010 Mar;25(1), p. 45-58.
PMID: 20182911
Related Citations

Grant Numbers:

AHRQ HHS - 5P01 HS10856

NIA NIH HHS - P30-AG15272

MeSH Terms:

United States	Factor Analysis, Statistical	Questionnaires
Ethnic Groups	Humans	Aged
Social Support	Middle Aged	Psychometrics
Female	Models, Theoretical

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Computerized prenatal genetic testing decision-assisting tool: a randomized controlled trial.
Authors: Kuppermann M, Norton ME, Gates E, Gregorich SE, Learman LA, Nakagawa S, Feldstein VA, Lewis J, Washington AE, Nease RF Jr
Source: Obstet Gynecol, 2009 Jan;113(1), p. 53-63.
PMID: 19104360
Related Citations

Grant Numbers:

AHRQ HHS - R18 HS10214

AHRQ HHS - P01 HS10856

MeSH Terms:

Aneuploidy	Patient Satisfaction	Decision Making, Computer-Assisted
Humans	Decision Making	Pregnancy
Patient Education as Topic	Chorionic Villi Sampling	Amniocentesis
Maternal Age	Adult	Down Syndrome
Prenatal Diagnosis	Pamphlets	Abortion, Eugenic
Female

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Ending cervical cancer screening: attitudes and beliefs from ethnically diverse older women.
Authors: Sawaya GF, Iwaoka-Scott AY, Kim S, Wong ST, Huang AJ, Washington AE, Pérez-Stable EJ
Source: Am J Obstet Gynecol, 2009 Jan;200(1), p. 40.e1-7.
EPub date: 2008 Oct 30.
PMID: 18976734
Related Citations

Grant Numbers:

NCRR NIH HHS - KL2 RR024130-03	NCI NIH HHS - U01 CA086117-05S2	NIA NIH HHS - P30 AG015272-12
NCI NIH HHS - U01-CA86117	AHRQ HHS - 5P01 HS10856	PHS HHS - PA-01-079
NIA NIH HHS - P30-AG15272	NCRR NIH HHS - KL2RR024130

MeSH Terms:

Uterine Cervical Neoplasms	Mass Screening	Ethnic Groups
Humans	Early Detection of Cancer	Interviews as Topic
Aged	Female	Multivariate Analysis

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Preferences for human papillomavirus testing with routine cervical cancer screening in diverse older women.
Authors: Huang AJ, Pérez-Stable EJ, Kim SE, Wong ST, Kaplan CP, Walsh JM, Iwaoka-Scott AY, Sawaya GF
Source: J Gen Intern Med, 2008 Sep;23(9), p. 1324-9.
EPub date: 2008 May 28.
PMID: 18506546
Related Citations

Grant Numbers:

NIA NIH HHS - P30 AG015272-11	AHRQ HHS - 5P01 HS10856	NIA NIH HHS - P30-AG15272
NCRR NIH HHS - KL2RR024130

MeSH Terms:

Patient Satisfaction	Humans	Aged
Uterine Cervical Neoplasms	Cross-Sectional Studies	San Francisco
Cervix Uteri	Aged, 80 and over	Vaginal Smears
Alphapapillomavirus	Interviews as Topic	Middle Aged
Papillomavirus Infections	Female

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Association between cancer risk perception and screening behavior among diverse women.
Authors: Kim SE, Pérez-Stable EJ, Wong S, Gregorich S, Sawaya GF, Walsh JM, Kaplan CP
Source: Arch Intern Med, 2008 Apr 14;168(7), p. 728-34.
PMID: 18413555
Related Citations

Grant Numbers:

AHRQ HHS - 5P01 HS10856

NIA NIH HHS - P30-AG15272

MeSH Terms:

Humans	Women	Aged
Breast Neoplasms	Uterine Cervical Neoplasms	California
Neoplasms	Colonoscopy	Risk Reduction Behavior
Hispanic Americans	Aged, 80 and over	Health Knowledge, Attitudes, Practice
Asian Americans	Health Behavior	Interviews as Topic
Middle Aged	Colonic Neoplasms	Female

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Race/ethnicity, socioeconomic status and the health of pregnant women.
Authors: Stewart AL, Dean ML, Gregorich SE, Brawarsky P, Haas JS
Source: J Health Psychol, 2007 Mar;12(2), p. 285-300.
PMID: 17284493
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10856	NIA NIH HHS - P30 AG15272	NICHD NIH HHS - R01 HD37389

MeSH Terms:

Vulnerable Populations	Questionnaires	Depression
Humans	Pregnancy	San Francisco
Health Status Indicators	Minority Groups	Social Class
Pregnant Women	Adult	Cohort Studies
Maternal Welfare	Middle Aged	Adolescent
Psychology, Social	Female

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Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment.
Authors: Schillinger D, Machtinger EL, Wang F, Palacios J, Rodriguez M, Bindman A
Source: J Health Commun, 2006 Oct-Nov;11(7), p. 651-64.
PMID: 17074733
Related Citations

Grant Numbers:

NCRR NIH HHS - K-23 RR16539-01	NCRR NIH HHS - M01RR00083-41	AHRQ HHS - P01 HS10856

MeSH Terms:

Evaluation Studies as Topic	Anticoagulants	Communication
Language	Comprehension	Warfarin
Professional-Patient Relations

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Overview of qualitative methods in research with diverse populations. Making research reflect the population.
Authors: Nápoles-Springer AM, Stewart AL
Source: Med Care, 2006 Nov;44(11 Suppl 3), p. S5-9.
PMID: 17060835
Related Citations

Grant Numbers:

NIA NIH HHS - P30-AG15272

AHRQ HHS - P10 HS10856

MeSH Terms:

Qualitative Research	Ethnic Groups	Humans
Health Status	Research Design

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The importance of establishing regimen concordance in preventing medication errors in anticoagulant care.
Authors: Schillinger D, Wang F, Rodriguez M, Bindman A, Machtinger EL
Source: J Health Commun, 2006 Sep;11(6), p. 555-67.
PMID: 16950728
Related Citations

Grant Numbers:

NCRR NIH HHS - K-23 RR16539-01	NCRR NIH HHS - M01RR00083-41	AHRQ HHS - P01 HS10856

MeSH Terms:

San Francisco	Anticoagulants	Patient Compliance
Humans	Communication	Interviews as Topic
Middle Aged	Physician-Patient Relations	Medication Errors
Male	Female

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Shared decision making and the experience of partnership in primary care.
Authors: Saba GW, Wong ST, Schillinger D, Fernandez A, Somkin CP, Wilson CC, Grumbach K
Source: Ann Fam Med, 2006 Jan-Feb;4(1), p. 54-62.
PMID: 16449397
Related Citations

Grant Numbers:

NCRR NIH HHS - K23 RR1018324	AHRQ HHS - 5P01 HS10856	NCRR NIH HHS - K23 RR16539

MeSH Terms:

Questionnaires	Patient Participation	Humans
Adult	Communication	Aged
Primary Health Care	Middle Aged	Mental Recall
Physician-Patient Relations	Male	Female

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A 21-year-old woman with atypical squamous cells of undetermined significance.
Authors: Sawaya GF
Source: JAMA, 2005 Nov 2;294(17), p. 2210-8.
PMID: 16264163
Related Citations

Grant Numbers:

AHRQ HHS - 1 P01 HS10856

MeSH Terms:

Humans	Papillomaviridae	Biopsy
Uterine Cervical Neoplasms	DNA, Viral	Mass Screening
Cervix Uteri	Metaplasia	Adult
Practice Guidelines as Topic	Vaginal Smears	Papillomavirus Infections
Colposcopy	Female

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Abortion attitudes of pregnant women in prenatal care.
Authors: Learman LA, Drey EA, Gates EA, Kang MS, Washington AE, Kuppermann M
Source: Am J Obstet Gynecol, 2005 Jun;192(6), p. 1939-45; discussion 1945-7.
PMID: 15970856
Related Citations

Grant Numbers:

AHRQ HHS - R18 HS10214	AHRQ HHS - P01 HS10856	NHGRI NIH HHS - R01 HG01255

MeSH Terms:

Attitude to Health	Humans	Abortion, Therapeutic
Prenatal Care	Pregnancy	California
Cross-Sectional Studies	Ethnic Groups	Adult
Cohort Studies	Interviews as Topic	Middle Aged
Adolescent	Female

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Women's misconceptions about cancer screening: implications for informed decision-making.
Authors: Denberg TD, Wong S, Beattie A
Source: Patient Educ Couns, 2005 Jun;57(3), p. 280-5.
PMID: 15893209
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10856

MeSH Terms:

Health Services Needs and Demand	Attitude to Health	Humans
Women	Aged	African Americans
Decision Making	San Francisco	Primary Prevention
Hispanic Americans	Aged, 80 and over	European Continental Ancestry Group
Informed Consent	China	Educational Status
Questionnaires	Socioeconomic Factors	Mass Screening
Neoplasms	Patient Education as Topic	Health Knowledge, Attitudes, Practice
Asian Americans	Middle Aged	Cultural Diversity
Female

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The effect of area HMO market share on cancer screening.
Authors: Baker LC, Phillips KA, Haas JS, Liang SY, Sonneborn D
Source: Health Serv Res, 2004 Dec;39(6 Pt 1), p. 1751-72.
PMID: 15533185
Related Citations

Grant Numbers:

AHRQ HHS - R01 HS10925	NCHS CDC HHS - P01 SH10771	AHRQ HHS - P01 HS10856
NCI NIH HHS - R01 CA81130

MeSH Terms:

United States	Mammography	Humans
Aged	Breast Neoplasms	Uterine Cervical Neoplasms
Socioeconomic Factors	Mass Screening	Managed Care Programs
Neoplasms	Adult	Vaginal Smears
Middle Aged	Adolescent	Prostatic Neoplasms
Female	Male	Health Care Sector

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Genetic testing and pharmacogenomics: issues for determining the impact to healthcare delivery and costs.
Authors: Phillips KA, Veenstra DL, Ramsey SD, Van Bebber SL, Sakowski J
Source: Am J Manag Care, 2004 Jul;10(7 Pt 1), p. 425-32.
PMID: 15298364
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10771	NIAID NIH HHS - R01 AI43744	AHRQ HHS - P01 HS10856
NCI NIH HHS - R01 CA81130

MeSH Terms:

United States	Genetic Testing	Managed Care Programs
Humans	Health Services Research	Delivery of Health Care
Breast Neoplasms	Warfarin	Pharmacogenetics
Female

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Willingness to recommend a health plan: who is dissatisfied and what don't they like?
Authors: Sakowski JA, Phillips KA, Liang SY, Haas JS
Source: Am J Manag Care, 2004 Jun;10(6), p. 393-400.
PMID: 15209483
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10771	AHRQ HHS - P01 HS10856	NCI NIH HHS - R01 CA81130

MeSH Terms:

Patient Satisfaction	Humans	Health Services Research
Adult	Retrospective Studies	Middle Aged
Insurance Carriers	Decision Making	Adolescent
Interprofessional Relations	Male	Female

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Does patient cost sharing matter? Its impact on recommended versus controversial cancer screening services.
Authors: Liang SY, Phillips KA, Tye S, Haas JS, Sakowski J
Source: Am J Manag Care, 2004 Feb;10(2 Pt 1), p. 99-107.
PMID: 15011810
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10771	AHRQ HHS - P01 HS10856	NCI NIH HHS - R01 CA81130

MeSH Terms:

United States	Mass Screening	Humans
Health Services Research	Diagnostic Services	Breast Neoplasms
Middle Aged	Cost Sharing	Deductibles and Coinsurance
Prostatic Neoplasms	Male	Female

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Moving beyond the typologies of managed care: the example of health plan predictors of screening mammography.
Authors: Tye S, Phillips KA, Liang SY, Haas JS
Source: Health Serv Res, 2004 Feb;39(1), p. 179-206.
PMID: 14965083
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10771	AHRQ HHS - P01 HS10856	NCI NIH HHS - R01 CA81130

MeSH Terms:

United States	Odds Ratio	Mammography
Women's Health	Humans	Referral and Consultation
Medicare	Aged	Breast Neoplasms
Primary Health Care	Health Services Accessibility	Quality Assurance, Health Care
Mass Screening	Managed Care Programs	Health Care Surveys
Logistic Models	Adult	Middle Aged
Female

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Is the prevalence of gatekeeping in a community associated with individual trust in medical care?
Authors: Haas JS, Phillips KA, Baker LC, Sonneborn D, McCulloch CE
Source: Med Care, 2003 May;41(5), p. 660-8.
PMID: 12719690
Related Citations

Grant Numbers:

AHRQ HHS - P01 HS10771	AHRQ HHS - P01 HS10856	NCI NIH HHS - R01 CA81130

MeSH Terms:

United States	Family Characteristics	Attitude to Health
Humans	Gatekeeping	Consumer Satisfaction
Cross-Sectional Studies	Managed Care Programs	Health Care Surveys
Trust	Adult	Cohort Studies
Middle Aged	Residence Characteristics	Physician-Patient Relations
Female	Male

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Social and familial context of prenatal genetic testing decisions: are there racial/ethnic differences?
Authors: Learman LA, Kuppermann M, Gates E, Nease RF Jr, Gildengorin V, Washington AE
Source: Am J Med Genet C Semin Med Genet, 2003 May 15;119C(1), p. 19-26.
PMID: 12704634
Related Citations

Grant Numbers:

AHRQ HHS - R18 HS10214	AHRQ HHS - P01 HS10856	NHGRI NIH HHS - R01 HG01255

MeSH Terms:

Attitude to Health	Humans	Decision Making
Multivariate Analysis	Pregnancy	Cross-Sectional Studies
Population Groups	Family Relations	Family
Social Support	Data Collection	Down Syndrome
Prenatal Diagnosis	Female

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Cost-effectiveness analyses in obstetrics & gynecology. Evaluation of methodologic quality and trends.
Authors: Subak LL, Caughey AB, Washington AE
Source: J Reprod Med, 2002 Aug;47(8), p. 631-9.
PMID: 12216429
Related Citations

Grant Numbers:

AHRQ HHS - P01-HS10856

NICHD NIH HHS - K12 HD01262-02

MeSH Terms:

Periodicals as Topic	Regression Analysis	Gynecology
Humans	Cost-Benefit Analysis	Practice Guidelines as Topic
Research	Time Factors	Research Design
Obstetrics	Female

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