(provided by candidate): ? Research has consistently shown that African-Americans with diabetes mellitus have worse health outcomes than whites. The literature also demonstrates that enhanced shared decision-making (SDM) and patient-centered care can improve diabetic outcomes. What we do not yet understand is why African-Americans have less shared-decision making than whites, how we can enhance shared decision-making in this population, and whether increasing SDM among African-Americans can lead to improvements in health outcomes and reductions in diabetic health disparities. I am an internist with an interest in exploring the impact of race/culture on the patient/provider relationship and reducing diabetic health disparities. Within the next five years, I want to be able to reduce African-American diabetic disparities by developing interventions grounded in research that enhance shared decision-making and diabetes self-management. In order to achieve this long-term goal, I plan to obtain additional research training through formal coursework, intensive mentoring, research conferences, and the completion of a series of research projects that include survey research methods, qualitative research, and behavioral intervention evaluation. My research proposal has the following specific aims: 1) To compare racial differences in patient preference for participatory decision-making and in the concordance between such preferences and physician behavior, 2) To explore how race and culture impact SDM between patients and health care providers, and 3) To develop and pilot test a culturally appropriate educational intervention for African-American patients with diabetes that enhances shared decision-making. By investigating and improving SDM among African-Americans with diabetes, we can make important advances in improving health outcomes and reducing health disparities within this population. This proposed research, along with additional training, will help me reach my goal of being an independent clinician investigator. Towards this end, I am able to draw upon the enormous strengths of two institutions with complementary resources and skills. Rush University Medical Center/John Stroger Hospital has an historic mission of providing care to primarily uninsured low-income ethnically diverse patients within a large public health system, while the University of Chicago has exceptional researchers and infrastructure with which to investigate issues of the medically underserved in a rigorous way. ? ?
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