Designing an Adolescent Centered Cards on the Table Toolkit

Abstract The proposed Phase I STTR project will develop the Cards on the Table Toolkit. The Toolkit will build on the existing prototype of Cards on the Table, a deck of cards containing questions related to seven essential topics of adolescent sexual and reproductive health counseling, including: STIs; contraception; healthy relationships; adolescent patients’ rights including confidentiality and consent; sexual health; social factors affecting adolescent health and their healthcare; and gender identity and sexual orientation. Developed using a human-centered design approach with adolescents and providers, the cards were designed to radically restructure the traditional clinical-driven counseling by allowing adolescents to select two to three cards from the deck to guide patient- provider communication during the visit. The current project will build on the existing cards to develop a digital version of the cards, as well as a wrap-around toolkit including educational information for adolescents and implementation guides for clinicians to incorporate the cards into their clinical practice. The Cards on the Table Toolkit will be implemented at the University of Chicago Medical Center among clinicians who see adolescent patients for primary care or for sexual and reproductive healthcare visits. Ten clinicians and 40 adolescents will be recruited to the study to evaluate the usability, feasibility and acceptability of the toolkit. The impact of the toolkit on knowledge, attitudes and patient-centered counseling experiences among adolescents will also be assessed. The Phase I project will culminate in a Cards on the Table Toolkit which will be prepared for Phase II full development, including the development of additional formats and refinement of implementation materials.Narrative Despite efforts to promote patient-centered counseling, there is an unmet need for patient-centered sexual and reproductive healthcare, particularly for Black, Latinx, and low-income adolescents. This proposal outlines the development and evaluation of the Cards on the Table Toolkit, a comprehensive, medically-accurate intervention that facilitates patient-provider communication about essential topics relevant to adolescent sexual and reproductive health and wellbeing. The key tenet of the intervention consists of the adolescent using the tool to select questions to discuss with their provider prior to the visit, thus radically restructuring the traditional provider-driven counseling. The Cards on the Table Toolkit will empower adolescents to set the agenda for the counseling visit, overcome issues of hierarchy and mistrust, and enhance engagement of adolescents in their own healthcare.