What's Gender Got to Do With It: Accounting for Differences in Incident Guideline Discordant Prescribing for PTSD Among Women and Men Veterans.

Objectives: Women veterans are more likely than men veterans to receive medications that Department of Veterans Affairs clinical practice guidelines recommend against to treat posttraumatic stress disorder (PTSD). To understand this difference, we examined potential confounders in incident prescribing of guideline discordant medications (GDMs) in veterans with PTSD.Methods: Veterans receiving care for PTSD during 2020 were identified using Veterans Health Administration administrative data. PTSD diagnosis was established by the presence of at least 1 ICD-10 coded outpatient encounter or inpatient hospitalization during the calendar year 2020. Incident GDM prescribing was assessed during 2021, including benzodiazepines, antipsychotics, select anticonvulsants, and select antidepressants. Log-binomial regression was used to estimate the difference in risk for GDM initiation between men and women, adjusted for patient, prescriber, and facility-level covariates, and to identify key confounding variables.Results: Of 704,699 veterans with PTSD, 16.9% of women and 10.1% of men initiated a GDM, an increased risk of 67% for women [relative risk (RR) = 1.67; 95% CI, 1.65-1.70]. After adjustment, the gender difference decreased to 1.22 (95% CI, 1.20-1.24) in a fully specified model. Three key confounding variables were identified: bipolar disorder (RR = 1.60; 95% CI, 1.57-1.63), age (<40 years: RR = 1.20 [1.18-1.22]; 40-54 years: RR = 1.13 [1.11-1.16]; ≥65 years: RR = 0.64 [0.62-0.65]), and count of distinct psychiatric medications prescribed in the prior year (RR = 1.14; 1.13-1.14).Conclusions: Women veterans with PTSD were 67% more likely to initiate a GDM, where more than half of this effect was explained by bipolar disorder, age, and prior psychiatric medication. After adjustment, women veterans remained at 22% greater risk for an incident GDM, suggesting that other factors remain unidentified and warrant further investigation.

Disentangling the coping process in White rural men who carry guns.

Affluent White rural men have the highest rates of gun ownership in the United States. However, few studies have specifically examined reasons and motivations for gun ownership and gun behaviors in this population. Therefore, this study sought to examine the relationship between stress variables, namely masculine gender role stress, adverse childhood experiences (ACEs), and income level, and subsequent pro-gun beliefs and amount of time an individual carried a gun within this population. Results indicated that only two measures of pro-gun beliefs (i.e., believing guns keep one safe, believing guns are present in one's social sphere) were correlated with percentage of time an individual carried. Additionally, ACEs were positively correlated with believing guns influence how others perceive oneself, levels of masculine gender role stress, and income. These results suggest that White rural gun owners who have increased ACEs have decreased income and tend to believe that owning guns impacts their social status with peers. However, increased ACEs do not influence belief about guns keeping one safe, believing guns are present in one's social sphere, or gun carriage. Instead, White rural gun owners without childhood adversity may be more susceptible to believing their safety depends on guns and belongingness within their social sphere. Future research should assess reasons why affluent White rural men find it important to maintain their safety in the context of gun ownership.

College students' perceptions of positive and negative drinking-related sexual experiences.

Objective: During young adulthood, drinking and sexual behaviors are both normative and inextricably linked. While this association is well documented, little is known about how students define positive and negative drinking-related sexual experiences. Methods: Thirty-five undergraduates participated in a focus group about sexual experiences in the context of drinking. Thematic analysis was utilized to identify themes in the data. Results: Students' descriptions of positive drinking-related sexual encounters included having a good time, feeling safe, maintaining control over alcohol, as well as feeling safe in drinking contexts where sexual partners are located. Students' perceptions of negative experiences included specific consequences such as a damaged reputation, loss of control due to alcohol, and concern of engagement in sex when they or a partner was too intoxicated to consent. Conclusion: Gaining a better understanding of how college students view positive and negative drinking-related sexual experiences could inform interventions aimed at promoting student well-being.

Veterans with chronic pain: Examining gender differences in pain type, overlap, and the impact of post-traumatic stress disorder.

BACKGROUND: Women are more likely to experience multiple overlapping pain conditions (MOPCs) relative to men. Post-traumatic stress disorder can negatively impact the severity and trajectory of chronic pain and its treatment. Specific associations between gender, post-traumatic stress disorder (PTSD), and MOPCs require further examination. METHODS: A cohort of all Veterans in 2021 who met criteria for one or more of 12 chronic pain types was created using national Veterans Health Administration administrative data. MOPCs were defined as the number of pain types for which each patient met criteria. Multivariable logistic regression models estimated gender differences in frequency for each of the 12 pain subtypes, after controlling for demographics and comorbidities. Negative binomial regression was used to estimate gender differences in the count of MOPCs and to explore moderation effects between gender and PTSD. RESULTS: The cohort included 1,936,859 Veterans with chronic pain in 2021, which included 12.5% women. Among those with chronic pain, women Veterans had higher rates of MOPCs (mean = 2.3) relative to men (mean = 1.9): aIRR = 1.31, 95% CI: 1.30-1.32. PTSD also served as an independent risk factor for MOPCs in adjusted analysis (aIRR = 1.23, 95% CI: 1.23-1.24). The interaction term between gender and PTSD was not significant (p = 0.87). Independent of PTSD, depressive disorders also served as a strong risk factor for MOPCs (aIRR = 1.37, 95% CI: 1.36-1.37). CONCLUSIONS: Individuals with MOPCs and PTSD may have complex treatment needs. They may benefit from highly coordinated trauma-sensitive care and integrated interventions that simultaneously address pain and PTSD. SIGNIFICANCE: Women were significantly more likely than men to experience MOPCs. PTSD was also significantly, independently, associated with MOPCs. Patients, particularly women, may benefit from tailored interventions that address both trauma and MOPCs.

Looking out for You and Me: College students' Strategies for Preventing Sexual Assault in Drinking Contexts.

Background: Sexual assault and heavy alcohol use are prevalent and interrelated public health concerns on university campuses. Surprisingly, however, few alcohol harm reduction interventions address this intersection to help students reduce both personal and community risks for sexual assault in college drinking contexts. Objectives: In the current study, students (ages 18-24) shared strategies they use to protect themselves and others from sexual assault in college drinking contexts, as well as challenges to implementing these strategies. A series of six focus groups were conducted across two universities in the U.S. (N = 35). Participants responded to open-ended questions focused on drinking and sexual assault (e.g., What are some of the things students might do to avoid or address situations where they feel pressured of coerced to hook up or have sex when they do not want to?). Results: Thematic analyses demonstrated students' awareness of protective behavioral and bystander intervention strategies that could help reduce vulnerability to experience sexual assault for themselves or others in drinking contexts. Perceived barriers to using bystander intervention strategies included student's own and friends' heavy drinking (decreased inhibitions, loss of autonomy), ambiguity in deciphering risk (lack of familiarity, minimization, diffusion of responsibility), and gender (gender norms, power imbalances). Conclusions: This study informs the development of interventions that help students identify strategies and overcome barriers to reduce risks for sexual assault in college drinking contexts.

Conceptualizations of interprofessional communication in intensive care units: findings from a scoping review.

BACKGROUND: Clinical errors in intensive care units (ICUs) are consistently attributed to communication errors. Despite its importance for patient safety and quality in critical care settings, few studies consider interprofessional communication as more than the basic exchange of information. METHODS: We conducted a scoping review of interprofessional communication in ICUs to (1) characterize how communication is defined and measured and (2) identify contributions the field of health communication can make to team communication in ICUs. Through a series of queries in PubMed and Communication and Mass Media Complete databases, we identified and compared persistent gaps in how communication is framed and theorized in 28 publications from health services and 6 from social science outlets. We identified research priorities and suggested strategies for discussing communication more holistically in future health services research. RESULTS: 34 articles published from 1999 to 2021 were included. Six explicitly defined communication. Six were published in social science journals, but none were authored by a communication studies scholar. Half of the articles addressed communication as a transaction focused on information transfer, and the other half addressed communication as a process. CONCLUSIONS: Methodological implications are identified with the intent to encourage future interdisciplinary collaboration for studying communication in ICUs. We discuss the importance of (1) using language to describe communication that facilitates interdisciplinary engagement, (2) prioritizing communication as a process and using qualitative methods to provide insight, and (3) engaging health communication theories and experts to assist in developing more fruitful research questions and designs.

Narrative Sense-Making During COVID-19: Using Stories to Understand Birth in a Global Pandemic.

Women who gave birth in the spring and summer of 2020 contended with a host of challenging factors. In addition to facing pregnancy, labor, and delivery during an emerging global pandemic, women grappled with health care restrictions that altered their birth experience. To explore how women made sense of their birth during COVID-19, we analyzed written narratives from 71 women who gave birth in the United States from March to July 2020. Based on tenets of communicated narrative sense-making, the themes that emerged from our data suggest that women framed the role of the pandemic as either completely overshadowing their birth experience or as an inconvenience. Women also wrote about threats to their agency as patients, mothers, and caregivers, as well as the evolving emotional toll of the pandemic that often prompted feelings of fear and sadness, along with self-identified anxiety and depression. We discuss these findings in light of the literature on birth stories as essential sites of narrative sense-making for women and their families.

'We need a culture change': military sexual trauma through the lens of rape culture.

Military sexual trauma remains a critical concern within the US military. One possible explanation for the persistence of this trauma is the presence of rape culture. This study examined perceptions of military sexual trauma within the framework of rape culture (i.e. traditional gender roles, sexism, adversarial sexual beliefs, hostility toward women, and acceptance of violence), in addition to associated factors, to address the US Department of Defense's call to focus on the role of culture on military sexual trauma. Focusing on culture is important as subtle norms in culture shape our behaviour and impact the excusal/perpetration of military sexual trauma. Identifying these norms may provide insight into factors to target in prevention efforts to reduce/eliminate military sexual trauma. Forty-two US service members responded to a series of open-ended questions. Standard content analysis procedures were utilised to determine themes. Results paint a complex picture of military sexual trauma, with participants demonstrating concern regarding military sexual trauma, but minimal acknowledgement of behaviour change to reduce military sexual trauma. These results are consistent with the observed increase in prevalence of military sexual trauma and decrease in reporting of it since 2018. Adding to the existing literature, participants noted the continued existence of rape culture within the military and the need for cultural change to address military sexual trauma.

Expectancy violations and boundary management when giving birth during a pandemic: implications for supporting women.

BACKGROUND: Few life events are as profound as the birth of a child. Yet for those who gave birth during the COVID-19 pandemic, the birth experience and the care of their newborn child were altered in significant ways. METHOD: In this study, we examined the stories of women who gave birth during the COVID-19 pandemic using expectations violations theory and communication privacy management theory. RESULTS: Based on focus group interviews with 65 women from 19 states across the U.S., we found that policies imposed by institutions and visitation rules negotiated by women were prominent in women's birth stories. Policies that affect territorial access to mothers and babies shaped communication to manage health and safety, resulted in intense emotional responses, and affected relationships with women's partners and families. CONCLUSIONS: Our findings offer practical implications for both health care systems and health care providers. Systems must communicate proactively to offer compassionate patient care, and physicians should offer guidance to help new parents manage visitors.

"I'm Not Comfortable With COVID, But ": Dilemmas and Decision-Making to Mitigate Risks Among Mothers Who Gave Birth During the COVID-19 Pandemic.

Individuals have faced unprecedented uncertainty and risk surrounding the COVID-19 pandemic, and decision-making dilemmas have been complicated by quickly evolving and often contradictory recommendations for staying healthy. Using tenets of problematic integration theory and risk orders theory, we analyzed interview data from 50 mothers who gave birth during the pandemic to understand how uncertainty and risk perceptions shaped their decision-making about keeping themselves and their infants healthy in the first year after birth. Results describe how some mothers in our sample made sense of their decision-making to prioritize first-order risks to their own and their family's physical health, and other mothers prioritized second-order risks to their relationships and identities. We also discuss the social nature of mitigating risk during the COVID-19 pandemic and the catalysts for shifting risk perceptions. Theoretical and practical implications include improving public health messaging and clinical conversations to enable individuals to effectively manage social and identity needs alongside serious threats to physical health.

"There Are Good and Bad Elements to It for Sure": Students' and Faculty/Staff's Perceptions of the Title IX Mandated Reporting Policy.

Faculty, staff, and students employed by or who serve as representative of universities in the United States are required by the Title IX federal law to report all instances of sexual harassment, discrimination, and sexual assault on college campuses. Despite the well-intended purpose of the Title IX regulations, less is known about campus communities' experiences and perceptions of this "mandated reporting," and its influence on disclosure. This exploratory mixed-methods study examines student (n = 88) and faculty and staff (n = 77) thoughts, concerns, and experiences regarding this policy at a mid-sized Northeastern University. Participants were recruited utilizing a campus lab system, with supplemental recruitment through student-life offices on campus. Data were collected via an anonymous survey hosted on the Qualtrics platform. Descriptive statistics were conducted for quantitative responses, whereas thematic analysis was utilized to analyze open text responses. Descriptive statistics demonstrate that the majority of participants (students and faculty/staff) were aware of their "mandated reporter" status. Additionally, students and faculty/staff varied regarding their support of the policy and the majority of faculty/staff had not had students disclose sexual violence to them and thus, had not reported any incidences of sexual violence to the university. Results of the thematic analysis further highlight the complexity of students and faculty/staff views' regarding the "mandated reporter" policy illustrating positive and negative perceived impacts of this policy, as well as several suggestions for improvement. Implications for research and practice are framed within the literature on Title IX, sexual harassment, and violence in the context of universities.

"It Made Me Not Want to See him ": The Role of Patient-Provider Communication in Influencing Rural-Dwelling Women Veterans' Motivation to Seek Health Care for Managing Chronic Pain.

Despite being high health care utilizers, many women Veterans perceive their pain condition to be poorly understood by their providers, which can be a strong demotivator for seeking care. We set out to understand the priorities rural-dwelling women Veterans have for using health care for their chronic pain, and interviewed participants about their experiences with (and priorities for seeking) health care for their chronic pain. Self-Determination Theory identifies three sources of motivation (autonomy, competence, relatedness), all of which were represented through two themes that reflect rural women Veterans' rationale for decision-making to obtain health care for chronic pain: role of trust and competing priorities. Women described their priorities for chronic pain management in terms of their competing priorities for work, education, and supporting their family, but most expressed a desire to function in their daily life and relationships. Second, women discussed the role of trust in their provider as a source of motivation, and the role of patient-provider communication skills and gender played in establishing trust. Rural women Veterans often discussed core values that stemmed from facets of their identity (e.g. gender, military training, ethnicity) that also influenced their decision-making. Our findings provide insight for how providers may use Motivational Interviewing and discuss chronic pain treatment options so that rural-dwelling women Veterans feel autonomous, competent, and understood in their decision-making about their chronic pain. We also discuss importance of acknowledging the effects of disenfranchising talk and perpetuating gendered stereotypes related to chronic pain and theoretical implications of this work.

"It is Hard to Think About": A Mixed-Method Exploration into the Application of the Theory of Compassion Collapse to the #MeToo Movement.

After the popularization of #MeToo in 2017, the conversation around sexual violence was brought to global attention. The collapse of compassion theory is proposed to occur in situations where individuals no longer feel increased levels of empathy due to an increase in the number of victims. This theory was employed to attempt to understand negative responses to #MeToo. The current study used a mixed methods exploratory approach to understand how exposure to multiple versus single victim(s) (image(s) and vignette) of sexual violence may affect participants' perception of survivors of sexual violence. We hypothesized that individuals who were exposed to multiple victims would demonstrate less compassion, higher levels of distance, more diffusion of responsibility, lower perceived efficacy, and less belief of the victim's story compared to individuals who were exposed to a single victim. We hypothesized that individuals with higher levels of rape myth acceptance (RMA) would endorse greater rates of distance and diffusion, and lower rates of compassion, efficacy, and belief. Participants, recruited via MTurk, were randomized into a single-image group or an eight-image group accompanied by a vignette explaining that the woma(e)n were victim(s) of sexual violence and naming the #MeToo movement. Participants in the single-image group expressed more belief in the victim's story and endorsed higher levels of psychological distance than the eight-image group. Higher rates of RMA related to less belief and compassion for victims and increased distance. In the qualitative analysis, three content areas were identified: (a) comments on woman(en), (b) comments on #MeToo, and (c) comments on sexual violence. The majority of responses expressed support for the #MeToo movement, with a smaller percentage expressing highly critical views including questions on the inclusivity of #MeToo and sexualization of the woman(en) in the vignettes. Implications and integration of results are discussed.

It's Complicated: Minority Stress, Social Support, In-Group Social Contact, and Sexual Minority Older Adults' Well-Being.

BACKGROUND AND OBJECTIVES: We applied the Minority Stress Model to sexual minority older adults to examine how distal minority stressors of ageism and heterosexism related to psychological well-being (life satisfaction, quality of life, psychological distress, and loneliness). We investigated social support and in-group social contact as stress-ameliorating factors and tested for a potential intersection of stress due to minority identities. RESEARCH DESIGN AND METHODS: A sample of 189 sexual minority older adults (50-86 years; M = 60.41) completed survey measures online. Hierarchical regression analyses with interaction terms were utilized to test study hypotheses. RESULTS: Findings offered partial support for the Minority Stress Model. Large effect sizes were obtained, explaining 32%-56% of the variance in psychological well-being with models including ageism, heterosexism, stress-ameliorating factors, and demographics. Ageism and heterosexism related to greater psychological distress; however, heterosexism became nonsignificant after controlling for stress-ameliorating factors. Ageism and heterosexism's relations to loneliness and quality of life followed similar patterns. Social support was a strong predictor of better psychological well-being for all measures. In-group social contact buffered against distress resulting from ageism, but heightened distress resulting from heterosexism. The interaction of ageism and heterosexism was not significant. DISCUSSION AND IMPLICATIONS: Ageism was a distinct source of distress for sexual minority older adults. Although social support emerged as crucial to well-being, the mixed findings related to in-group contact as a stress-ameliorating factor may indicate a need for tailored social engagement to optimize community connection as protective for sexual minority older adults.

Anabolic Steroid Use and Intimate Partner Violence Among Sexual Minority Men.

This study examined the relationship between intimate partner violence (IPV) and use of anabolic-androgenic steroids (AAS), in a relationship context, among men who have sex with men (MSM). The sample was collected online via Prolific.co and consisted of 491 MSM. Data were analyzed using structural equation modeling. While accounting for the influence of factors known to be linked to IPV (adverse childhood experiences and alcohol use), the use of AAS in a relationship context was uniquely linked to greater perpetration of IPV. AAS use was not uniquely linked to IPV victimization. Findings from this study contribute to literature on IPV among MSM by including a group-specific risk factor (AAS use) in modeling risk for IPV. Limitations, implications, and future directions for research are discussed.

Towards Understanding Disparities in Using Technology to Access Health Care Information: African American Veterans' Sociocultural Perspectives on Using My HealtheVet for Diabetes Management.

The digital divide, a racial disparity in computer and internet use, persists among Veterans. This study examined African American Veterans' experiences with and attitudes about using My HealtheVet (MHV), the online patient portal used in the Department of Veterans Affairs (VA) health care system. Semi-structured interviews were conducted with 35 non-Hispanic African American Veterans about preferences for health information, use of web-enabled devices, and experiences with and preferences for using MHV. Twenty-nine men and 6 women, ranging 35 to 73 years old, participated in this study. About 75% (n = 26) had completed some college or more, and about 75% (n = 26) considered their families financially comfortable. Ninety-one percent (n = 32) of participants were aware of MHV, and 78% (n = 25) of those who were aware reported having enrolled for an account. Data revealed participants valued that MHV provided realistic solutions to cumbersome aspects (e.g., phone call hold-times) of receiving care at the VA. However, participants admitted to not using the patient portal at all or to its full potential for two reasons: a) preference for their pre-MHV routine, b) distrust in the institutional, technological, and organizational aspects surrounding MHV. By highlighting the sociocultural aspects of patient portal use, this study provides a meaningful explanation for barriers and facilitators of health information technology adoption, particularly for MHV among African American Veterans, and ways practitioners may influence uptake.

The Role of Minority Stressors in Digital Dating Abuse Victimization and Perpetration among Sexual Minority Men.

Digital dating abuse (DDA), a manifestation of intimate partner violence (IPV), is becoming more relevant. Despite elevated rates of IPV among sexual minority individuals and increased experiences of DDA, research has focused largely on face-to-face forms of IPV (e.g., physical assault) among presumed heterosexual couples. The minority stress theory offers a lens through which we can understand the elevated rates of IPV, including DDA, among sexual minority individuals. The purpose of this study was to explore the role of minority stressors in DDA victimization and perpetration among sexual minority men. A sample of 491 cisgender gay and bisexual men (Mage = 31.35, SDage = 11.60) was recruited online. Consistent with prior research, discrimination was associated positively with internalized homophobia (IHP). Discrimination and IHP were directly linked to DDA victimization and perpetration. Indirect effect from discrimination to DDA victimization and perpetration, mediated by IHP, were significant. This study highlights the relationship between minority stressors and DDA among sexual minority men and indicates the need for more work on DDA among marginalized groups including sexual and gender minorities.

The impact of COVID-19 on domestic violence agency functioning: A case study.

Initial evidence suggests that rates of intimate partner violence (IPV) increased at the beginning of the COVID-19 pandemic. However, much of the prevalence research has focused on survivors' experiences of IPV during the initial lockdown period from March to June 2020. The current study adds to this initial research by centering the experience of a domestic violence agency located in the United States, 3-months prior to, during, and after the COVID-19 lockdown. The results suggest a similar pattern across service utilization (e.g., total clients served, calls, safe house capacity) and survivor demographics (e.g., race/ethnicity, cisgender women and men), with an initial decrease in service utilization from pre-lockdown to lockdown and an increase, surpassing pre-lockdown, post-lockdown. The only deviations from this pattern of service utilization were for sexual minority individuals, whose service utilization continued to decline post-lockdown and Asian American/Pacific Islander and trans/gender-nonbinary survivors who rarely utilized services across the time period. Additionally, the domestic violence agency relied heavily on their existing finances, well-rounded staff training, and staff wellbeing throughout the pandemic. The unique challenges that COVID-19 provided demanded flexibility, increased technological utilization, and additional funding particularly for safe housing. Implications for future research, intervention, and policy change are provided below.

The Perioperative Pain Self-Management (PePS) randomized controlled trial protocol: Preventing chronic post-surgical pain and prolonged opioid use.

BACKGROUND: Total joint arthroplasties are common orthopedic surgeries that carry risk for developing chronic post-surgical pain. In addition to pre- and post-operative pain severity, psychological distress (e.g., anxiety, pain catastrophizing) is a risk factor for chronic postsurgical pain. Cognitive behavioral therapy (CBT) for chronic pain is an empirically supported approach to managing chronic pain, functional impairment, and related distress. While CBT has been used extensively in patients with established chronic pain, using it as a preventive intervention targeting the transition from acute to chronic postsurgical pain is a novel application. OBJECTIVES: The Perioperative Pain Self-Management (PePS) program is a pain self-management intervention based on the principles of CBT. This innovative intervention is brief, flexible, and is delivered remotely. The current study aims to determine the efficacy of PePS compared to standard care on reducing the incidence of significant surgical site pain at 6-months post-surgery. The current study also aims to evaluate the context for subsequent implementation. METHODS: This study is a hybrid type I efficacy-preparing for implementation trial. It is a two-site, single-blind, two-arm, parallel, randomized control trial. Surgical patients will be randomized to either receive: 1) PePS plus standard care, or 2) Standard care. The primary end point will be surgical site pain severity at 6-months post-surgery. CONCLUSION: Results from this study are expected to result in support for a brief scalable intervention (PePS) that can prevent the development of chronic pain and prolonged post-surgical opioid use, as well as key details to inform subsequent implementation. CLINICALTRIALS: govIdentifier:NCT04979429.

My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity.

BACKGROUND: Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. OBJECTIVE: We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. DESIGN: We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. PARTICIPANTS: Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. KEY RESULTS: Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. CONCLUSIONS: Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.