UAB readies rural shared decision-making pilot for older adults with multiple chronic conditions
The University of Alabama at Birmingham is preparing to test a revised My Health Priorities program aimed at older adults in rural and underserved communities in the Deep South who live with multiple chronic conditions. The planned pilot, registered as MyHP-South, is designed around a familiar bedside problem: patients with several serious illnesses often need to make tradeoffs, yet the values guiding those tradeoffs are not always clear to clinicians or family members.
The trial is not built to measure a hard clinical endpoint such as hospitalization, mortality, or symptom burden. Instead, it focuses on whether a structured priorities-based conversation can be delivered in a way that patients, caregivers, and clinicians find understandable, relevant, and usable. In practice, that makes the study a test of communication infrastructure. If the intervention is awkward, culturally mismatched, or difficult to complete, it will not matter how thoughtful the content is.
A dyadic intervention built around values, not prescriptions
MyHP-South uses a single-group, open-label design with no randomization and no masking. The intervention will be delivered to patient-caregiver dyads, and the study also includes clinicians who will judge whether the approach fits a primary care setting. Participants will complete the revised program during a Zoom or in-person session, then return for questionnaire follow-up by telephone before and 12 weeks after the session.
The clinical logic is straightforward. Older adults with multiple chronic conditions often face competing recommendations from different specialists, and those tensions can become more pronounced when treatment burdens accumulate. A tool that helps patients articulate health priorities may support decisions about medication intensity, symptom goals, or how aggressively to pursue additional testing. When family caregivers are part of that discussion, the conversation may become more realistic and less fragmented, especially when the patient depends on unpaid support to navigate appointments and day-to-day care.
One sentence captures the study’s practical stake: if the program cannot be used easily, the communication problem remains exactly where it started.
Enrollment criteria point to a medically complex, socially exposed group
Eligibility is tightly defined. Patients must identify as African American or White/Caucasian, be at least 65 years old, speak English, and have at least two chronic conditions drawn from cancer, heart disease, kidney disease, liver disease, or lung disease. They must also be cognitively able to take part in decision-making discussions, have a family caregiver who meets study criteria, and have reliable telephone access. Caregivers must meet similar language and cognitive requirements, be at least 18 years old, and provide unpaid help or support with health-related decision-making.
Several exclusions sharpen the target population further. Patients with documented dementia, those unable to understand the study or provide informed consent, and individuals living in nursing homes or assisted living facilities are not eligible. Caregivers who cannot communicate with research staff or complete the dyadic session and assessments are also excluded. The result is a study focused on community-dwelling older adults whose decision-making is still possible, but whose illness burden is high enough to make those decisions unusually difficult.
That combination matters at the bedside. These are the patients in whom standard disease-specific counseling often collides with fatigue, transportation barriers, and competing family perspectives.
Feasibility, usability, and caregiver engagement are the real endpoints
The primary outcome measures are centered on feasibility and acceptability. Investigators will use the System Usability Scale for patients and caregivers, each assessed through ten Likert-type questions about usability and accessibility of the revised tool. A separate acceptability interview asks patients and caregivers together to answer 26 open-ended questions about their experience with the program. Recruitment feasibility will be judged by the number and proportion of eligible dyads who enroll, while retention and completion feasibility will be measured by how many enrolled dyads complete baseline assessments, the MyHP-South session, immediate post-session assessments, the acceptability interview, and the 12-week follow-up.
Those choices reveal what the study is really trying to answer. Before any efficacy claim is possible, the intervention has to survive the messy realities of rural care delivery: scheduling, telehealth access, caregiver availability, and the cognitive load of discussing priorities across several chronic diseases. The use of both Zoom and telephone reflects that reality. It also hints at an implementation question that extends beyond this single protocol—whether a values-based decision aid can remain useful when the patient is not sitting in a tertiary care clinic with abundant support services.
The revised program itself is described as helping participants clarify health-related values and communicate those priorities to family caregivers and healthcare providers. That is a clinically meaningful aim because treatment decisions in multimorbidity often hinge less on one disease than on how a patient weighs longevity, function, symptom relief, and burden of care. A tool that surfaces those priorities could reduce misalignment between what clinicians recommend and what patients actually want.
A small pilot with a large implementation question
The study is estimated to enroll 44 participants and is scheduled to begin in 2027, with primary completion and study completion both estimated for December 31, 2027. It is listed as an interventional, non-applicable phase study sponsored by UAB, with Deborah Ejem as the responsible party and Alexis M Johnson listed as a study contact.
Because this is a pilot, the most important readout will not be a dramatic efficacy signal. The critical question is whether the intervention can be delivered reliably to rural older adults and their caregivers in a way that preserves clarity, cultural relevance, and usability. If those elements hold together, MyHP-South could provide a workable model for shared decision-making support in primary care settings where multiple chronic conditions are the rule rather than the exception.
If they do not, the burden of complex illness will still fall on families trying to make sense of competing recommendations without a structured guide.
Why the Deep South setting matters
The setting gives the protocol its urgency. Rural and underserved older adults often face narrower access to specialty care, less frequent continuity with the same clinician, and more dependence on family members for medical decision-making support. In that environment, a program that organizes goals and values into a usable format may have more practical value than another disease-specific checklist. The study’s emphasis on African American and White/Caucasian participants also reflects the population it intends to reach, though the protocol does not claim to solve broader inequities in access on its own.
For now, MyHP-South remains a feasibility study, not a test of clinical outcome improvement. Its main contribution will be whether a structured priorities conversation can be made workable for dyads living with high chronic disease burden in a region where those conversations are often delayed, rushed, or left to unfold informally at home.