Shared Decision-Making to Reduce Racial Disparities in Oral Anticoagulation Use in Patients with Non-Valvular Atrial Fibrillation

共同决策以减少非瓣膜性心房颤动患者口服抗凝药使用中的种族差异

• 批准号: 10282856
• 负责人: Larry R Jackson
• 金额: $ 16.18万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10282856
• 关键词: Address; Adherence; Adoption; Anticoagulants; Anticoagulation; Arrhythmia; Atrial Fibrillation; Award; Awareness; Benefits and Risks; Biomedical Research; Cardiac; Cardiology; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical; Clinical Trials Design; Communication; Competence; Conflict (Psychology); Consent; Counseling; Data; Decision Making; Development; Diagnosis; Disease; Education; Ensure; Equilibrium; Ethnic group; Evidence based intervention; Faculty; Feedback; Future; Goals; Guidelines; Health system; Healthcare; Heart Abnormalities; Intervention; Interview; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Measures; Medicine; Mentors; Oral; Outcome; Outcome Measure; Patient Preferences; Patient-Centered Care; Patients; Perception; Physicians; Pilot Projects; Primary Care Physician; Primary Health Care; Process; Professional Organizations; Provider; Psychologist; Questionnaires; Race; Randomized Clinical Trials; Research; Research Personnel; Research Proposals; Research Training; Risk; Role; Sampling; Scientist; Stroke; Stroke prevention; Structure; Testing; Therapeutic Intervention; Training; United States; Universities; Work; acceptability and feasibility; base; black patient; care outcomes; career; clinical practice; design; effectiveness testing; efficacy testing; empowered; ethnic minority population; evidence base; experience; feasibility testing; health care delivery; health care disparity; health care quality; health literacy; heart rhythm; implementation science; improved; improved outcome; medical schools; patient oriented; patient-clinician communication; primary outcome; professor; racial and ethnic; racial disparity; racial minority; randomized trial; satisfaction; shared decision making; skills; social; stroke risk; support tools; tool development; uptake

Blacks with non-valvular atrial fibrillation (NVAF) are less likely to receive oral anticoagulants (OAC) for stroke prevention compared with Whites. This is notable given that Blacks have a 3-fold greater risk of NVAF-related ischemic stroke compared to Whites. My long-term goal is to reduce racial disparities in arrhythmia (defined as an abnormal heart rhythm) care. My goal in applying for a Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research is to acquire the research skills and hands-on experience necessary to become a productive, independent, clinician-scientist. My research focuses on addressing racial disparities in the use of OAC in patients with NVAF. Candidate and Mentors: I am an Assistant Professor of Medicine at Duke University’s School of Medicine where I practice as an cardiac electrophysiologist. My primary mentor, Dr. Kevin Thomas, has expertise in healthcare disparities, specifically the contributors to lower quality of health care delivery and outcomes among racial and ethnic minority populations. Research and Training: The goal of this research proposal is to develop a patient decision support tool aimed at facilitating shared decision making, improving decision quality, and increasing the uptake of OAC in Blacks with NVAF. Shared decision making, aided through the use of patient decision support tools, has been associated with improved outcomes including increased knowledge, less decisional conflict, and increased uptake of therapeutic interventions. Unfortunately, Blacks are more likely to experience non-participatory decision making than non-racial and ethnic minority populations. In this proposal, I will: 1) conduct interviews among Black and White patients with NVAF and clinicians to understand the barriers and facilitators toward participating in shared decision making regarding use of OACs; 2) develop and iteratively evaluate a patient decision support tool; and 3) conduct a pilot study to assess the feasibility and acceptability of a patient decision support tool to facilitate shared decision making. The training plan will prepare me for a career aimed at addressing racial disparities in arrhythmia care and will include education in 1) implementation science to promote the adoption of our patient decision support tool in clinical practice; 2) accruing skills in the design and testing of patient decision support tools; and 3) design of clinical trials to assess the efficacy of our intervention. This research will provide data to support a R01 proposal to test the efficacy of a patient decision support tool to improve shared decision making, decision quality, and potentially increase the use an adherence of OAC in Blacks in a multisite randomized clinical trial. Summary: The proposed research will lead to the development of a patient decision support tool intervention used to facilitate shared decision making in Blacks with NVAF, improve decision quality, and potentially increase the uptake of OAC in Blacks with NVAF. The K01 Diversity award will support my development into a leader in healthcare disparities research with the goal of promoting patient-centered care by empowering patients to make informed, values- based decisions needed to improve decision quality and potentially reduce racial disparities in arrhythmia care.

患有非瓣膜性房颤（NVAF）的黑人不太可能接受口服抗凝剂（OAC）治疗中风 与白人相比，这是值得注意的，因为黑人有3倍的NVAF相关风险 与白人相比，我的长期目标是减少心律失常的种族差异（定义为 心律异常）的护理。我申请辅导职业发展奖的目标是促进 生物医学研究的教师多样性是为了获得必要的研究技能和实践经验 成为一个多产独立的临床科学家我的研究重点是解决种族差异， NVAF患者使用OAC。候选人和导师：我是一名医学助理教授， 我在杜克大学医学院实习，是一名心脏电生理学家。我的导师，博士。 凯文·托马斯（Kevin Thomas）在医疗保健差异方面拥有专业知识，特别是导致医疗保健质量较低的因素 在种族和少数民族人口中的交付和成果。研究和培训：本项目的目标 研究建议是开发一种旨在促进共同决策的患者决策支持工具， 提高决策质量，并增加NVAF黑人对OAC的摄取。共同决策， 通过使用患者决策支持工具，与改善的结果相关，包括 增加知识，减少决策冲突，并增加治疗干预的吸收。不幸的是， 黑人比非种族和少数民族更有可能经历非参与性决策 人口。在本提案中，我将：1）对NVAF黑人和白色患者进行访谈， 临床医生了解参与关于使用的共同决策的障碍和促进因素 2）开发并反复评估患者决策支持工具; 3）进行试点研究， 评估患者决策支持工具的可行性和可接受性，以促进共同决策。的 培训计划将为我的职业生涯做好准备，旨在解决心律失常护理中的种族差异，并将包括 教育在1）实施科学，以促进采用我们的病人决策支持工具，在临床 实践; 2）在设计和测试患者决策支持工具方面积累技能; 3）设计临床 来评估我们干预的效果这项研究将提供数据，以支持R 01提案， 患者决策支持工具在改善共享决策、决策质量和潜在 在一项多中心随机临床试验中，增加OAC在黑人中的使用和依从性。摘要：拟议 研究将导致患者决策支持工具干预的发展，用于促进共享 在NVAF黑人的决策，提高决策质量，并可能增加OAC的吸收， 黑人NVAF K 01多样性奖将支持我发展成为医疗保健差异的领导者 研究的目标是促进以病人为中心的护理，使病人知情，价值观- 基于决策需要提高决策质量，并可能减少心律失常护理中的种族差异。