Background: The Centers for Disease Control and Prevention (CDC)’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain offers guidance on opioid tapering and encourages clinicians to work collaboratively with patients in the decision-making process. Opioid tapering is the process of gradually reducing the dosage of prescription opioid medications. CDC assessed clinicians’ informational needs and preferences around tapering, and tested materials intended to support patient-provider communication around tapering.

Methods: CDC interviewed clinicians (n=9), in July 2023, to explore their knowledge, attitudes, and beliefs about tapering; effective strategies for patient conversations about tapering; and challenges to having conversations with patients. Insights from these in-depth interviews were used to develop materials. In September 2023, materials were tested with a new set of clinicians (n=9) to gather their feedback regarding content, design, clarity, relevance, and utility.

Results: Findings emphasized the importance of building trust within the patient-provider relationship and creating a collaborative approach where patients feel seen and heard in the decision-making process. These conversations highlighted the challenges clinicians face when having conversations with patients about tapering. Clinicians reacted positively to the materials developed, which CDC updated based on their feedback and suggestions.

Conclusions: Given the ongoing overdose crisis, supporting and training clinicians in having productive conversations with patients about tapering continues to be important. CDC remains committed to evaluating materials and resources and using feedback from clinicians to improve current resources, as well as inform future materials development. The tapering materials developed as part of this process are currently available.

Trauma experienced during childbirth can have a significant and lasting negative impact on birthers’ health and well-being. Because this trauma is related more to birthers’ self-evaluation of and reactions to the event than the event itself, they are often re-traumatized when their trauma goes unrecognized, is minimized or dismissed, or is deemed unwarranted – especially when the baby is healthy. Nearly one-third of birthers (N=3330) responding to an online survey reported feeling traumatized by their birthing experience. Although birthers of color reported a higher incidence of traumatization, it was not statistically greater than for whites. For birthers with a disability, however, the odds of being traumatized was 2.14 [CI 1.16, 4.10] that of cisabled birthers. Negative communication with providers was associated with feeling traumatized among all birthers (r=.85) with strong correlations in birthers of color (r=.89) and those with a disability (r=.92). Perceived environmental control (r= -.56) and partner support (r=-.54) were negatively associated with birth trauma Approximately 13% of birthers reported having flashbacks or nightmares about their birth and 7.5% reported having feelings of self-harm or harming their baby. Birth related trauma and PTSD are significant public health issues. Interventions aimed at improving provider communication, especially among marginalized birthers, may mitigate these harms.

Background: Understanding the relationship among patient-centered communication (PCC), social determinants of health (SDoH), and quality of healthcare and health status is crucial in healthcare research for improving both individual health outcomes and healthcare quality. This study aims to investigate how PCC and SDoH influence perceived quality of care and individual health, both directly and through the mediating role of self-efficacy.

Methods: We utilized a national sample of 6,252 adults from the Health Information National Trends Survey (HINTS) 6. PCC was evaluated as a latent variable using seven indicators, while SDoH were assessed through four indicators. Self-efficacy to take care of their health was the mediator in our model. Structural equation modeling (SEM) was employed to examine how self-efficacy mediates the effects of PCC and SDoH on the outcomes, perceived healthcare quality and self-reported general health status.

Results: The final structural model exhibited good fit with the data (RMSEA: 0.04, CFI: 0.99; TLI: 0.97; SRMR: 0.03). Lower SDoH needs were significantly associated with greater patients’ self-efficacy to take care of their health (p < 0.05). Perceived quality of healthcare and self-reported general health were positively and significantly associated with PCC. Self-reported general health was also positively influenced by SDoH (p<0.05). Lastly, self-efficacy positively and significantly mediated the relationship of both PCC and SDoH on both outcomes, quality of care and self-reported general health status (p<0.05).

Conclusion: Future research should delve deeper into the nuanced interactions among patient-provider communication, SDoH, and self-efficacy, informing targeted interventions to enhance healthcare quality and individual well-being.

Background: Effective patient-provider communication is important for diabetes management. However, patients are often reluctant to openly share their concerns with providers. This integrated mixed-method RCT sought to assess the impact of the Diabetes & Hypertension Self-Management Program (DHSMP) on participants’ self-advocacy (SA) and communication with their providers.

Methods: Ninety-eight adults were randomized to 3 arms: a 12-week DHSMP core (N=33), 12-week DHSMP core plus medication adherence (n=33) or enhanced usual care (3 hours of education; N=32). Patient SA and communication were assessed at baseline, 12- and 24-weeks using validated measures. Semi-structured interviews (n=45) and 7 focus groups (n=25) were conducted. Four coders used thematic analysis to identify themes related to SA and communication. Data were integrated using MAXQDA software.

Results: SA was significantly associated with patient-provider communication (r=0.40; p<0.001), diabetes duration (r=0.22; p<0.001), BMI (r=-0.13; p=0.045), glucose monitoring (r=0.15; p=0.018), and diabetes distress (r=-0.15; p=0.019). Quantitatively, the intervention arms compared to the control group saw improvements in SA at 12 weeks (p=0.021) but was not sustained at 24 weeks (p=0.746). However, qualitatively, participants in the intervention arms shared that the DHSMP (1) promoted positive perceptions of SA and increased participants’ confidence to effectively communicate their needs with providers, and (2) helped them discuss self-management topics, including psychosocial aspects.

Conclusion: The DHSMP’s impact results on SA were mixed. Results demonstrated that diabetes education alone may not be enough to improve SA. Future research testing interventions that specifically incorporate teaching SA skills in addition to diabetes self-management behaviors is needed.