Evidence-based psychosocial interventions (EBPIs) are first-line treatments for PTSD yet very few patients receive them, even in the Veterans Health Administration (VA) where there is excellent access to EBPIs. Patients’ preferences for and initiation of EBPIs are influenced by how providers present and discuss these PTSD treatment options. In specialty mental health settings, shared decision making (SDM) increases initiation of and adherence to EBPIs for PTSD, yet fewer than half of VA patients with PTSD are seen in specialty settings, whereas most are seen in primary care.

This R03 will use the Discover, Design/Build, and Test (DDBT) framework to adapt an existing VA SDM protocol for primary care settings. The research aims are: Aim 1 (Discover): Identify the decision support needs of service recipients (N=25 primary care patients with PTSD) and identify adaptations to an existing VA decision support tool using the “think-aloud” protocol to improve usability. Aim 2 (Design/Build): Generate initial prototypes of a primary care-based SDM protocol—Patient Readiness for Improvement through Motivation, Engagement, and Decision-making (PRIMED)—using storyboarding and clinical workflow mapping, then conduct prototype testing with service providers (N=10-12 clinicians) to identify the most usable approach(es) to incorporating decision support into routine practice. Aim 3 (Test): Conduct a single-arm test of PRIMED with N=10 patient-provider dyads.

This research will support a future grant application to pilot test PRIMED in a larger randomized controlled trial. The intervention has the potential to improve access to evidence-based psychosocial interventions for PTSD by enhancing shared decision making in primary care settings where most VA patients with PTSD receive care, ultimately increasing initiation and adherence to first-line PTSD treatments.