Group-randomized trial of tailored brief shared decision-making to improve asthma control in urban black adults.
Maureen George, Jean-Marie Bruzzese, Marilyn Lynn S Sommers and 8 others
PMID 33249632WHAT IT FOUND
The brief asthma shared decision-making visit did not outperform a control visit for asthma control in Black adults.
BREATHE participants reported more shared decision-making and improved their own asthma control score by more than 0.5.
Key findings
01For asthma control outcomes, between-group tests were not significant, so the trial did not show that BREATHE improved asthma control more than the control visit.
02Only BREATHE participants had improvements in asthma control at all timepoints that exceeded the minimal clinically important difference of 0.5, while control participants had significant improvements at 1 and 3 months.
03BREATHE participants reported higher perceived shared decision-making than control participants immediately after the intervention (β = 7.39; p = 0.03).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Between-group tests were not significant, so within-group gains cannot be attributed to BREATHE rather than the control visit. The sample was small and follow-up was short: 80 adults followed for 3 months, with 76 completing. The trial used two urban federally-qualified health centers and enrolled Black/African American or multiracial adults with uncontrolled asthma who endorsed erroneous beliefs, so it may not apply to other settings or populations. Self-referral and clinician referral may have selected patients who were more motivated or already engaged. Patients knew they were in a trial and may have reported what they thought the team wanted to hear. Clinicians were not blinded, and data collectors correctly guessed assignment in 49 of 80 cases, so masking was not fully achieved. Fidelity to the fourth BREATHE step, engaging in shared decision-making, was lower than the other steps at 73.7%. Clinician retention was lower than patient retention, and two clinicians were replaced. The active group had 8 asthma-related adverse events and the control group had 5. One death occurred in the active group and was judged unlikely related.
The easy way to misread this
Do not read BREATHE participants' own asthma control score gains above the 0.5 minimal clinically important difference as proof it beat the control visit. Between-group tests were not significant, and the control visit also improved.