The Impact of Measurement-Based Care in Psychiatry: An Integrative Review.

BACKGROUND: The quality of mental health treatment has not progressed to the same extent as physical health treatment. Suboptimal mental health outcomes may be attributed to the lack of a systematic approach to tracking and measuring patient progress. In psychiatry, Measurement-Based Care (MBC) offers an objective, systematic approach to monitor clinical progress, evaluate treatment efficacy, and inform clinical decisions, yet remains seldom used in daily practice. AIMS: To identify the clinical impact of using MBC in psychiatry. METHODS: Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query, "What is the clinical impact of Measurement-Based Care when treating patients with mental illness?" RESULTS: A total of nine articles met the inclusion criteria for this integrative review. The articles ranged from 2008 to 2021. The following themes were identified from the analysis of these articles: (1) the clinical impact of MBC, (2) provider attitudes about MBC, and (3) barriers to MBC implementation. CONCLUSIONS: MBC, augmenting usual standard care, provides an objective, systematic approach using quantifiable data to monitor symptom severity and treatment effectiveness. This review highlights the clinical benefits of MBC, including increased remission rates, lower risk of relapse, improved medication adherence, and strengthening the therapeutic alliance. Although this review provides an overview of the benefits of MBC in psychiatry, there remains a substantial practice gap warranting further investigation. Strategies must be developed to address barriers at the individual and organizational levels which impede the successful adoption of MBC.

HPV immunization among young adults (HIYA!) in family practice: A quality improvement project.

AIMS: Thousands of anogenital and oropharyngeal cancers every year might be prevented through increased receipt of vaccination against the human papillomavirus (HPV). This project aimed to (1) increase the rate of HPV vaccination status assessment, and (2) improve HPV vaccine initiation and completion rates among 18 to 26-year-old patients in the family practice setting. DESIGN: Quality improvement project, pre/post intervention design. METHODS: This project implemented the HIYA! (HPV Immunization among Young Adults) Intervention in a private sports and family practice in central New Jersey. HIYA! implemented 10 pre-, during, and post-visit outcome measures during every family medicine visit with an 18 to 26-year-old patient for HPV. Data collection involved retrospective chart review of every eligible patient during the 12-week implementation period from 17 August to 06 November 2020 and during the same 12-week control period in 2019. RESULTS/FINDINGS: One hundred sixteen charts from 2019 and 129 charts from 2020 were reviewed for assessment of HPV vaccination status and HPV vaccine initiation and/or completion. Multivariable logistic regression analysis demonstrated that participants in the control group were 84% less likely to be assessed for HPV vaccination status and were 91% less likely to initiate and complete HPV vaccination compared with the intervention group. CONCLUSION: This QI project found HIYA! to be an effective and feasible strategy to improve HPV vaccination rates among 18 to 26-year-old patients in a family practice setting. IMPACT: The human papillomavirus (HPV) is the most common sexually transmitted disease in the United States, and causes thousands of cancers annually. Although vaccination against HPV can prevent these cancers, vaccination rates remain low, particularly among young adults ages 18 to 26 years. The positive impact of HIYA! was evident based on its success despite the unique challenges presented during the implementation period due to the COVID-19 pandemic.

Strategies to improve human papillomavirus vaccination rates among adolescents in family practice settings in the United States: A systematic review.

AIMS AND OBJECTIVES: To explore the interventions aimed at increasing human papillomavirus (HPV) vaccination rates among adolescents in family practice settings. BACKGROUND: HPV is the most common sexually transmitted disease in the United States, and the cause of thousands of anogenital and oropharyngeal cancers annually. Although HPV infection can be prevented with recommended vaccination during adolescence, national HPV vaccine rates remain low. DESIGN: Systematic review. METHODS: Four databases (MEDLINE, CINAHL, EMBASE and the Cochrane Library) were searched. The search was guided by PRISMA and by the question, 'What are targeted interventions that improve HPV vaccination rates among adolescents in family practice settings?' Articles were reviewed for study characteristics and appraised for quality using the revised Cochrane risk of bias tools. RESULTS: Eleven studies met inclusion and exclusion criteria. Individual study size samples ranged from 749-147,294, with a combined total from all included studies of 276,205; the largest sample reviewed to date from family practice settings. Interventions used to increase HPV vaccination rates included reminder systems; provider and staff education; sensory incentives such as hitting a gong or petting a puppy; and iPad tailored messaging programmes. Studies that employed interventions pre-, during and postvisit were most effective in increasing HPV vaccination rates. CONCLUSIONS: This review provides the largest data supporting multimodal strategies to increase HPV vaccination rates among adolescent populations. It provides strong evidence to suggest that vaccination rates can be improved using measures at varying times of the patient visit. RELEVANCE TO CLINICAL PRACTICE: Adolescents seek health care in various settings. Many studies have examined interventions to increase HPV vaccination in paediatric settings, but few have examined interventions in family practice settings. This review suggests that family practices should implement multimodal measures before, during and after visits to increase HPV vaccination among adolescent patients.

Interprofessional education and collaboration among healthcare students and professionals: a systematic review and call for action.

Interprofessional education (IPE) is a prerequisite to building a collaborative practice environment and optimizing patient care. The purpose of this systematic review was to assess the impact of IPE on outcomes related to health-care pre-licensure learners and professionals, including: changes in attitudes/perceptions; acquisition of knowledge regarding other disciplines' roles and development of collaborative skills; and change in collaborative behavior. We searched PubMed, CINAHL, Embase, and ERIC for studies published from 2007 to 2017 in English; 19 studies were eligible. The Joanna Briggs Institute appraisal tool was used to assess the quality of the studies. Thirteen studies used a quasi-experimental design. The studies varied in terms of setting, teaching methods, assessment measures, and quality. Seventeen of the 19 studies (89%) that assessed change in attitudes toward other disciplines and value placed on a team-based approach for improving patient care, found statistically significant improvements. All seven of the studies that assessed change in collaborative behavior found statistically significant improvements. Among the 12 studies that assessed the development of collaborative skills, there were mixed results. Future directions include: conducting more studies among health-care professionals, assessing the long-term impact of IPE, objectively assessing change in collaborative behavior, and assessing the impact of IPE on patient-centered outcomes.

Psychometric Properties of the Person-Centered Version of the Alcohol and Alcohol Problems Perceptions Questionnaire (PC-AAPPQ).

AIMS: Given the importance of addressing provider attitudes toward individuals with unhealthy alcohol use and the current emphasis on person-centered language to help decrease stigma and mitigate negative attitudes, the aim of this study was to evaluate the psychometric properties of a contemporary version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) that uses person-centered language and addresses the spectrum of alcohol use. METHODS: The authors created a person-centered version of the AAPPQ (PC-AAPPQ) and conducted a cross-sectional study of its psychometric properties in academic settings in the Northeastern United States. The PC-AAPPQ was administered to 651 nursing students. Reliability analysis of the new instrument was performed using the total sample. Only surveys with complete data (n = 637) were randomly split into two datasets, one used for the exploratory factor analysis (EFA) (n = 310) and the other for confirmatory factor analysis (CFA) (n = 327). RESULTS: Compared to all the models generated from the EFA, neither the original six-factor structure nor the five-factor structure was superior to any of the other models. The results indicate that a seven-factor structure with all 30 items is the best fit for the PC-AAPPQ. CONCLUSIONS: The PC-AAPPQ represents a positive effort to modernize the four-decade-old AAPPQ. This 30-item instrument, which adds one additional subscale, offers a means to assess providers' attitudes using respectful wording that avoids perpetuating negative biases and reinforces efforts to affirm the worth and dignity of the population being treated.

Delirium point prevalence studies in inpatient settings: A systematic review and meta-analysis.

AIMS: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. BACKGROUND: Delirium-a common and distressing condition manifesting as an acute decline of attention and cognition-is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. DESIGN: A systematic review and meta-analysis. METHODS: A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random-effects meta-analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta-analysis. RESULTS: Nine studies were included in the review, with sample sizes ranging from 47-1867. Delirium point prevalence ranged from 9%-32%. Hypoactive delirium was the most common subtype, ranging from 23%-78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. CONCLUSIONS: Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies. RELEVANCE TO CLINICAL PRACTICE: Consistent identification of high-risk patients and treatment settings with elevated risk, accompanied by the implementation of effective preventive and management strategies, are critical to addressing delirium-a frequent and burdensome condition, that adversely affects patient outcomes.

Nurse-Led Delivery of Brief Interventions for At-Risk Alcohol Use: An Integrative Review.

BACKGROUND: Nurses are in key positions to reduce the global burden associated with alcohol, yet many are ill-prepared to screen for alcohol use and intervene accordingly. The purpose of this integrative review was to identify best practices for educating nurses to work with patients who are at risk for alcohol-related adverse consequences, implement alcohol screening, and deliver alcohol brief interventions (ABIs). AIMS: To identify and synthesize findings from randomized control trials of ABIs delivered by nurses to patients identified through screening to be at risk because of alcohol use. METHOD: The results of 11 published randomized control trials identified from a multi-database search were synthesized. RESULTS: The Alcohol Use Disorder Identification Test was used for alcohol screening in more than half of the studies. Most of the ABIs were based on motivational interviewing and delivered in 30 minutes or less. While there was limited information on the characteristics of nurses who delivered the interventions and how nurses were prepared to deliver the ABIs, the exemplar was a full day workshop teaching nurses on an evidence-based framework for the ABI. All studies measured alcohol consumption as an outcome, yet few used rigorous methods for obtaining this self-reported data. CONCLUSIONS: A 1-day workshop is recommended as an educational modality to prepare nurses to implement the Alcohol Use Disorder Identification Test for identification of persons who are at risk because of alcohol use, deliver a structured brief intervention in less than 30 minutes, and utilize a standard measure of alcohol consumption for evaluation.

Assessing neuropsychiatric symptoms in people with dementia: a systematic review of measures.

BACKGROUND: Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps. METHODS: We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980-December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties. RESULTS: Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties. CONCLUSIONS: A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.

Knowing versus doing: education and training needs of staff in a chronic care hospital unit for individuals with dementia.

Hospital clinical staff routinely confront challenging behaviors in patients with dementia with limited training in prevention and management. The authors of the current article conducted a survey of staff on a chronic care hospital unit concerning knowledge about dementia, perceived educational needs, and the care environment. The overall mean score for a 27-item knowledge scale was 24.08 (SD = 2.61), reflecting high level of disease knowledge. However, staff indicated a need for more information and skills, specifically for managing behaviors nonpharmacologically (92.3%), enhancing patient safety (89.7%), coping with care challenges (84.2%), and involving patients in activities (81.6%). Although most staff (i.e., nurses [80%] and therapists [86.4%]) believed their care contributed a great deal to patient well-being, approximately 75% reported frustration and being overwhelmed by dementia care. Most reported being hit, bitten, or physically hurt by patients (66.7%), as well as disrespected by families (53.8%). Findings suggest that staff have foundational knowledge but lack the "how-to" or hands-on skills necessary to implement nonpharmacological behavioral management approaches and communicate with families.

Considerations of Intersectionality for Older Adults with Palliative Care Needs in the Emergency Department: An Integrative Review.

Purpose of Review: We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw's Theory of Intersectionality was conducted in accordance with Whittemore and Knafl's five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality. Recent Findings: Older adults aged 60 and above in the United States (US) account for more than 20% of ED visits annually, and half of older adults will visit the ED in their last year of life. There has been a growing focus on adapting the ED to meet the palliative care needs of older adults, but relatively little consideration has been given to older adults' intersectional identities. Summary: Six articles were identified that provided indirect insights into the status of intersectionality in ED-based palliative care for older adults. Two areas of interest were identified: (1) intersectional elements or reference to such elements embedded within the studies; and (2) the challenges of adapting quantitative methodologies to incorporate variables and approaches that would allow for intersectional analysis. This review highlights areas for future research along with recommendations for adopting an intersectional framing into commonly used methodologies.

Corrigendum to Older adult and family caregiver preferences for emergency department based-palliative care: An experience-based co-design study.

[This corrects the article DOI: 10.1016/j.ijnsa.2020.100016.].

Oncology Nursing Telephone Triage Workshop: Impact on Nurses' Knowledge, Confidence, and Skill.

BACKGROUND: Outpatient oncology nurses are responsible for symptom assessment/management and care coordination during telephone triage. Nursing telephone triage interventions can improve patient outcomes and clinical efficiency. Therefore, the lack of education and training in telephone triage can greatly impact patient care. OBJECTIVE: Using a prospective pretest/posttest design, we sought to determine if a telephone triage educational workshop would improve oncology nurses' knowledge, confidence, and skill over 12 weeks. INTERVENTION/METHODS: The educational intervention incorporated an online didactic lecture, group case scenario, and feedback on a virtual triage simulation. Evaluation was conducted before and after the intervention through an online, 13-item survey (knowledge and confidence) and simulation utilizing a 56-item checklist (skills). RESULTS: Thirteen oncology nurses were enrolled; 54% did not have telephone triage experience before this job. A total of 12 participants completed the workshop. From pretest to posttest, there was a median 1.0 out of 5.0 (interquartile range, 2.8) improvement in confidence (P = .008) and a 26.3% (interquartile range, 15.2) improvement in skills (P = .002). There was no difference in knowledge scores from pretest to posttest (P = .11). CONCLUSIONS: This workshop was associated with an improvement in oncology nurse confidence and skill, using telephone triage models. It benefits an existing process within the outpatient center and it highlights a new educational strategy that may optimize nursing practice and improve patient care and experience. IMPLICATIONS FOR PRACTICE: This workshop contributes to existing evidence of telephone triage models and nursing education. The findings can guide future research, nursing orientation, and educational activities within the field of nursing and telehealth.

Capturing the value and core concepts of the Clinical Research Nurse.

Background: As nurses, we identify our profession as a caring one, but how does this identity translate from a conceptual definition, to real-world practice for the Clinical Research Nurse? Aim: To offer a novel, four-point conceptual model that encapsulates the Clinical Research Nurse's intrinsic value, active leadership, and direct contribution to high quality, person-centered, safe care, addressing current misperceptions of research nursing. Methods: This paper describes the provision of 'care', safely delivered by the Clinical Research Nurse through a four-point conceptual model and case-driven example. Discussion: Clinical research nursing is conceptualized within the domains of Care and Trust, Role, Impact, and Integration. The case example demonstrates real-world application of these domains and the expertise required to balance the complexities of clinical needs and research demands in a healthcare environment. Conclusions: This paper offers a mechanism for understanding the importance of the Clinical Research Nurse and their role in maintaining safety and a high-level view of the care arena. These reflections are considered with an international application for the role.

Changes in Nursing Students' Attitudes and Perceptions After Receipt of Enhanced Substance Use-Related Curricular Content.

BACKGROUND: Negative attitudes toward persons who use alcohol and other drugs contribute to suboptimal care. Nurses are in key roles to address the needs of this population, yet they lack the education needed to identify persons who may be at risk because of substance use and intervene accordingly. The purpose of this study was to evaluate the impact of a substance-use-related curriculum on nursing students' attitudes and therapeutic commitment for working with patients with alcohol- and drug-use-related problems. METHODS: Data were collected for four cohorts of 169 nursing students enrolled in a Master's Entry into Nursing program. Questionnaires included the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire and the Drug and Drug Problems Perception Questionnaire, completed before and after completing the curriculum. Paired samples t test were used to examine pre/post differences for each measure's subscale. RESULTS: Four of the seven Person-Centered Alcohol and Alcohol Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, role legitimacy, and general perceptions. Four of the five Drug and Drug Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, job satisfaction, and role legitimacy; there was a significant change in role-related self-esteem, however, in a negative direction. CONCLUSIONS: This study adds to the growing evidence of the positive impact of providing evidence-based information and skill development, which enhance alcohol- and drug-related knowledge and competence for nurses entering professional practice.

Does the Length of Time to Complete an Online Program Matter?

Health care providers are challenged to meet the simultaneous demands of delivering clinical care and acquiring new information, especially in the context of the coronavirus disease 2019 pandemic, the opioid epidemic, and concurrent escalation in alcohol and other drug use. To address the gap in knowledge related to substance use, screening, brief intervention, and referral to treatment (SBIRT), a self-paced online educational program, was developed and delivered to 169 learners. Posttest knowledge scores increased for all learners and did not differ based on their pace of completion. Results indicated that this module provides a means for busy clinicians to increase their ability to manage substance use, even if their learning occurs in multiple sessions interrupted by other pressing demands. Future iterations of this course could further enhance clinical competency by addition of an online clinical simulation component. [J Contin Educ Nurs. 2021;52(11):505-510.].

Older adult and family caregiver preferences for emergency department based-palliative care: An experience-based co-design study.

Background: Older adults (>65 years) with palliative care needs are increasingly accessing the emergency department. Some interventions have been developed to improve the care provided, but the majority of research has focused on provider perspectives. Limited understanding of patient and family experiences and priorities means important needs may be overlooked. Objectives: To explore patient and family caregiver experiences and identify their improvement priorities for emergency department-based palliative care delivery. Design: A participatory action research design, experienced-based co-design, was adopted. Filmed and audio-recorded interviews and individual feedback sessions were used to capture patient data. Setting: An urban emergency department in the UK. Participants: Six patients aged ≥65 with palliative care needs and four family caregivers were recruited from the emergency department. Methods: Participants took part in individual or dyad audio-recorded or filmed interviews. Interview data were analyzed using thematic framework analysis. One-to-one feedback sessions with participants were used to validate findings and rank the themes to identify patient and family priorities for improvement. Results: The analysis identified five prominent themes that captured the patient and family experience of emergency department-based palliative care. 1) Systems and processes; 2) communication and information; 3) changing expectations (of what can be done for one's health on a personal and system level); 4) recommendations (for improving palliative care in the emergency department); and, 5) acknowledgement and validation (of the patient and family). All themes except 'recommendations' were selected as improvement priorities. Within the context of these improvement priorities, participants provided rich insights into their perceptions of care and identified small but significant actions that could be implemented to improve their experiences of palliative care in the emergency department. These included being offered a drink or phone call, being included in conversations about their care, and being kept informed of what was happening with their care. Conclusions: Older people with palliative care needs and their family caregivers were able to share their experiences and highlight improvement priorities for emergency department care using the experience-based co-design approach. Their experiences offer new perspectives, which can be used alongside emergency department and palliative care clinician perspectives to support service and outcome measure development in future emergency department-based palliative care. Tweetable abstract: #EBCD study shows older adults with #PalliativeCare needs value communication, compassion & inclusion in #SharedDecisionMaking in the #ED.

Place of Death for Persons With and Without Cognitive Impairment in the United States.

BACKGROUND/OBJECTIVES: There is increasing recognition that place of death is an important component of quality of end-of-life care (EOLC) and quality of death. This study examined where older persons with and without cognitive impairment die in the United States, what factors contribute to place of death, and whether place of death influences satisfaction with EOLC. DESIGN: Cross-sectional secondary data analysis. SETTING: In-person interviews with community-dwelling proxy respondents. PARTICIPANTS: Data were collected from 1,500 proxies for deceased participants in the National Health and Aging Trends Study (NHATS), a nationally-representative sample of community-dwelling Medicare beneficiaries aged 65 and older. MEASUREMENTS: Study variables were obtained from the NHATS "last month of life" interview data. Survey weights were applied to all analyses. RESULTS: Persons with cognitive impairment (CI) most often died at home, while cognitively healthy persons (CHP) were equally likely to die at home or in a hospital. Persons with CI who utilized the Medicare Hospice Benefit were 14.5 times more likely to die at home than in a hospital, and 3.4 times more likely to die at home than a nursing home. CHP who use this benefit were over six times more likely to die at home than in a hospital, and more than twice as likely to die at home than a nursing home. Place of death for CHP was also associated with age and race. Proxies of persons with CI who died at home rated EOLC as more favorable, while proxies of CHP rated in-home and hospital care equally. CONCLUSION: Findings add to the scant literature identifying factors associated with place of death for older adults with and without CI and results suggest that place of death is a quality of care indicator for these populations. These findings may inform EOLC planning and policy-making and facilitate greater well-being at end-of-life.

Caregiver Reactions to Aggressive Behaviors in Persons With Dementia in a Diverse, Community-Dwelling Sample.

Purpose: To describe caregiver challenges with and confidence managing three aggressive behavior types in persons with dementia: verbal aggression, destroying property, and threatening to hurt others. Design and Method: Secondary analysis of baseline data from the 2001-2004 Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) initiative. Results: One or more aggressive behaviors within 1 week were reported by more than a third of caregivers, with most expressing upset but fewer expressing confidence managing the behaviors. Caregiver distress and confidence differed by race/ethnicity in response to verbal aggression, with more White/Caucasian caregivers expressing upset than Hispanic/Latinos or Black/African Americans. Fewer Hispanic/Latinos expressed confidence managing verbal aggression, compared with White/Caucasians or Black/African Americans. Discussion: Aggressive behaviors challenge caregivers, with reactions varying by behavior type and race/ethnicity. Cultural and contextual factors suggest the need to tailor interventions, especially skill-building interventions that increase confidence managing aggressive behaviors while decreasing upset.

Integrating Substance Use Content in an "Overcrowded" Nursing Curriculum.

Various factors have compelled nurse educators to address the lack of substance use-related content in nursing curriculum. Initiatives to add this content are often met with resistance because of an already crowded curriculum. This article describes a 4-phase process that guided the integration of this specialty content into a prelicensure nursing curriculum and a master's level advanced practice nursing curriculum. Lessons learned and recommendations from those experiences are provided to guide nurse educators undertaking similar efforts.

It's a Matter of Trust: Older African Americans Speak About Their Health Care Encounters.

PURPOSE: To examine perceptions of older African Americans' encounters with health care providers and ways to enhance trust. METHOD: Transcribed semi-structured interviews with African American senior center members were analyzed, using Pattern Coding method. RESULTS: Four themes emerged: "Added Insult of Ageism," "Alternative Remedies," "Good Providers in a 'Broken' System," and "The Foundation of Trust Is Person Recognition." Provider behaviors leading to mistrust included erroneously assuming stereotypical preferences and competence, spending inadequate time listening to patients, disregarding patient preferences, and insufficiently explaining treatments. DISCUSSION: Of importance to improving trust among older African American patients is valuing individual histories and preferences by reallocating scarce time to person-centered listening, individualizing treatments, more completely explaining interventions, and assuring that patients understand and agree with treatment plans.