Decision conflict and the decision support needs of HIV PrEP-eligible Black patients in Toronto regarding the adoption of PrEP for HIV prevention

Abstract

Objectives: This study examined factors contributing to decision conflict and the decision support needs of PrEP-eligible Black patients. Methods:The Ottawa Decision Support Framework (ODSF) was used to guide the development of a key informant guide used for qualitative data collection. Black patients assessed by healthcare providers as meeting the basic criteria for starting PrEP were recruited through the St. Michael's Hospital Academic Family Health Team and clinical and community agencies in Toronto. Participants were interviewed by trained research staff. Qualitative content analysis was guided by the ODSF, and analysis was done using the Nvivo. Results: Four women and twenty-five men (both heterosexual and men who have sex with men) were interviewed. Participants reported having difficulty in decision making regarding adoption of PrEP. The main reasons for decision-conflict regading PrEP adoption were: lack of adequate information about PrEP, concerns about the side effects of PrEP, inability to ascertain the benefits or risk of taking PrEP, provider's lack of adequate time for interaction during clinical consultation, and perceived pressure from healthcare provider. Participants identified detailed information about PrEP, and being able to clarify how their personal values align with the benefits and drawbacks of PrEP as their decision support needs. Conclusion:Many PrEP-eligible Black patients who are prescribed PrEP have decision conflict which often causes delay in decision making and sometimes rejection of PrEP. Healthcare providers should offer decision support to Black patients who are being asked to consider PrEP for HIV prevention.

Development of a Web-Based HIV Pre-Exposure Prophylaxis (PrEP) Decision Support Tool to Improve Decision-Making for PrEP-eligible Black Patients (Preprint)

“…Scoping: Assessment of Patients' and Clinicians' Views on Decisional Needs We conducted key informant interview of 29 PrEP-eligible Black patientsdifferent gender, sexual orientation, and at different decision-making stage -to understand their decision-making process and to assess their decision support needs for PrEP. The result of this phase of the development process has been reported by Ajiboye et al (12). We also surveyed 25 PrEP providers (clinical and service providers) to assess needs and preferences for a decision support tool for PrEP-eligible Black patients.…”

“…The goal is to reduce decision conflict for Black patients, promote evidence-based decision on PrEP, and enhance implementation of the chosen HIV prevention option. For the providers' survey, we found that most providers ( 93% ) agreed that a decision support tool will complement the service they provide to their PrEPeligible Black patients (12). They identified Black patients' need for culturally appropriate information on the benefits and risks of PrEP as one of the reasons why a decision support tool would be needed.…”

“…Factors affecting acceptance of PrEP are multi-dimensional and are related to; lack of knowledge, low perception of risk of HIV acquisition, preference for other prevention options, healthcare providers' attitude, cost of PrEP, lack of drug coverage, lack of primary care physician, inadequate consultation time with providers, anti-Black racism, and PrEP stigma (8)(9)(10)(11)(12)(13). In addition, for most PrEPeligible Black Canadians, the availability of multiple options to prevent HIV, and the lack of adequate knowledge about these options, including information on the benefits and drawbacks of these options present decision-making challenges on whether to accept PrEP or not for HIV prevention (12). These challenges underscore the necessity to improve decision making process for Black Canadians who are being asked to consider PrEP for HIV prevention.…”

“…Decision support interventions have been developed for various medical therapies, diagnostic tests, preventive therapies, clinical trial entry decision, and end of life decisions (14,17). However, there is currently no patient decision support intervention for Black patients being asked to consider PrEP for HIV prevention, especially in the context of previous studies indicating that most of these patients do have decisional conflict regarding PrEP (12,17). Therefore, the aim of this study was to develop and evaluate a decision support intervention to improve decision-making process for Black patients who are offered PrEP for HIV prevention.…”

“…A search of both published and grey literatures were conducted to identify evidence for inclusion in the tool (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). We also reviewed data obtained from our study of patients' and providers' assessment of decisional needs (12,22). Data from our study on assessment of patients' decision support needs and preferences were qualitatively analyzed.…”