A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead.
A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead.
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DOI：
10.1016/j.jpainsymman.2022.03.017
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发表时间：
2022-07
影响因子：
4.7
通讯作者：
Williams, Jessica
中科院分区：
文献类型：
--
作者：
Chuang, Elizabeth;Yu, Sandra;Georgia, Annette;Nymeyer, Jessica;Williams, Jessica
本文的目的是回顾现有文献中关于临终关怀和临终关怀质量方面的种族差异的文献，并说明在探索产生这些差异的潜在机制方面存在的差距。几十年来无数的研究表明，与白人患者相比，美国的医疗体系始终会产生质量较差的黑人临终关怀。减少这些差距的有效干预措施很少，而且由于对这些差距的根本原因的了解有限而受到阻碍。我们在PubMed、CINAHL和mental Info上搜索研究手稿，这些研究手稿测试了关于黑人患者临终关怀差异的因果机制的假设。这些研究按国家少数民族健康和健康差距研究所(NIMHD)框架中概述的领域进行分类，这些领域包括生物、行为、物理/建筑环境、社会文化和卫生保健系统领域。在这些领域内，研究被进一步归类为侧重于个人、人际、社区或社会层面的影响。大多数研究集中在医疗保健系统和社会文化领域。在卫生保健系统领域，研究平均分布在个人、人际和社区层面的影响，但较少关注社会层面的影响。在社会文化领域，大多数研究都集中在个体层面的影响。那些关注个人影响力水平的人往往质量较差。社会文化环境、物理/建筑环境、行为和生物领域仍然是临终关怀中种族差异的潜在原因机制研究不足的领域。在医疗保健系统领域，包括医疗保健政策和法律在内的社会影响没有得到充分的研究。在社会文化领域，大多数研究仍然侧重于个人层面的影响，缺少关于人际歧视以及地方和社会结构性歧视的关键领域的研究。关注个别因素的研究应该得到更好的筛选，以确保它们的高质量，避免给黑人社区蒙上污名。
The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps in the exploration of underlying mechanisms that produce these disparities. Countless studies over several decades have revealed that our healthcare system in the United States consistently produces poorer quality end-of-life for Black compared with White patients. Effective interventions to reduce these disparities are sparse and hindered by a limited understanding of the root causes of these disparities. We searched PubMed, CINAHL and PsychInfo for research manuscripts that tested hypotheses about causal mechanisms for disparities in end-of-life care for Black patients. These studies were categorized by domains outlined in the National Institute of Minority Health and Health Disparities (NIMHD) framework, which are biological, behavioral, physical/built environment, sociocultural and health care systems domains. Within these domains, studies were further categorized as focusing on the individual, interpersonal, community or societal level of influence. The majority of the studies focused on the Healthcare System and Sociocultural domains. Within the Health Care System domain, studies were evenly distributed among the individual, interpersonal, and community level of influence, but less attention was paid to the societal level of influence. In the Sociocultural domain, most studies focused on the individual level of influence. Those focusing on the individual level of influence tended to be of poorer quality. The sociocultural environment, physical/built environment, behavioral and biological domains remain understudied areas of potential causal mechanisms for racial disparities in end-of-life care. In the Healthcare System domain, social influences including healthcare policy and law are understudied. In the sociocultural domain, the majority of the studies still focused on the individual level of influence, missing key areas of research in interpersonal discrimination and local and societal structural discrimination. Studies that focus on individual factors should be better screened to ensure that they are of high quality and avoid stigmatizing Black communities.
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影响因子：
4.7
作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Payne, Richard;Tulsky, James A.
通讯作者：
Tulsky, James A.
影响因子：
4.7
作者：
Cruz-Oliver，Dulce M.;Tseng，Tuo-Yen;Knowlton，Amy R.
通讯作者：
Knowlton，Amy R.
影响因子：
6.3
作者：
Byhoff E;Harris JA;Langa KM;Iwashyna TJ
通讯作者：
Iwashyna TJ
影响因子：
4.7
作者：
Boyce-Fappiano D;Liao K;Miller C;Peterson SK;Elting L;Guadagnolo BA
通讯作者：
Guadagnolo BA
DOI：
10.1046/j.1532-5415.2002.50073.x
发表时间：
2002-02-01
影响因子：
6.3
作者：
Degenholtz, HB;Arnold, RA;Lave, JR
通讯作者：
Lave, JR