Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training.
Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training.
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DOI：
10.1186/s12916-023-03193-y
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发表时间：
2024-01-09
期刊：
影响因子：
9.3
通讯作者：
Hardy, Billie-Jo
中科院分区：
文献类型：
--
作者：
Smylie, Janet;Rotondi, Michael A.;Filipenko, Sam;Cox, William T. L.;Smylie, Diane;Ward, Cheryl;Klopfer, Kristina;Lofters, Aisha K.;O'Neill, Braden;Graham, Melissa;Weber, Linda;Damji, Ali N.;Devine, Patricia G.;Collins, Jane;Hardy, Billie-Jo
关键词：
土著人民的医疗保健经常失败，反土著种族主义在临床遭遇中很常见。旨在提高土著文化安全（ICS）的临床培训计划依赖于学习者报告的影响评估，即使临床医生自我评估与观察或患者结果报告的相关性很差。我们的目的是比较密集和简短的ICS培训的临床影响，以控制，并评估ICS培训评估工具的可行性，包括未经宣布的土著标准化患者（UISP）访问。采用前瞻性平行组三臂随机对照试验设计和设盲的标准化患者，我们比较了密集的互动，专业促进，8 - 10小时Sanyas ICS培训的临床影响;简短的1小时反偏见培训，以解决反土著偏见;和对照继续医学教育的时间-注意力匹配的强化培训。参加者包括来自加拿大多伦多四家教学医院的58名非土著工作人员医生、住院医生和执业护士以及一个急诊科。主要结局指标为UISP访视期间提供的护理质量，包括UISP向朋友或家庭成员推荐临床医生的调整几率;患者护理体验的平均项目评分; NSAID更新和疼痛评估的临床实践指南依从性。强化或短期ICS组的临床医生被标准化患者高度推荐给朋友和家人的调整后几率较高（OR 6.88，95%CI 1.17至40.45和OR 7.78，95%CI 1.05至58.03）。与对照组相比，参加强化和简短培训项目的临床医生的校正平均项目患者体验评分分别高出46%（95% CI 12%至80%）和40%（95% CI 2%至78%）。小样本量排除了检测培训对临床实践指南依从性的影响; 100%的UISP访视未被参与临床医生检测到。以患者为导向的评价设计和工具，包括UISP被证明是可行和有效的。结果表明，文化安全培训对临床医生的患者推荐和改善患者体验的潜在影响。需要进行更大规模的试验，以进一步确定对临床实践的影响。Clinicaltrials.org 追溯登记于2023年6月5日。在线版本包含补充材料，可通过10.1186/s12916 - 023 - 03193-y获得。
Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023. The online version contains supplementary material available at 10.1186/s12916-023-03193-y.
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DOI：
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