Articulating External Factors that Limit UF Outcomes for All Women and Create Disparities for BAA women

PROJECT SUMMARY – PROJECT 2 External factors including insurance coverage, patient-clinician relationships, and healthcare policies limit personalized uterine fibroid (UF) care and shared decision-making for women. These factors are magnified for Black/African American (BAA) women secondary to distrust between medical providers, and specifically gynecologists and BAA contributing to a situation whereby women generally desire uterine sparing procedures while nearly 60% of women undergo hysterectomy without prior conservative therapy. This project seeks to understand the external factors contributing to barriers to wider use of conservative nonsurgical treatment options that have widespread endorsement of their safety and efficacy. The specific aims are to 1) analyze predictors of UF treatment adoption and outcomes in BAA and White women in a large commercially insured population and assess the impact of Medicaid expansion on access to UF treatments and outcomes specifically focusing on disparities between BAA and White women; 2) assess via focus groups non- gynecologic and gynecologic providers’ knowledge, standard of treatment, and comfort with approaches when providing care to patients for the treatment of UF; 3) conduct a discrete choice experiment to understand provider preferences for treatment options. Since healthcare decisions are primarily influenced by healthcare providers that vary on context, barriers identified will be utilized to decrease disparities in offering medical and uterine sparing therapies. Through dissemination of the findings and collaboration with the administrative corps, pilot projects will be supported to bring diverse early-stage investigators into the fields of policy and research to empower personalized and evidence-based decision making. 1