Targeting Bias to Reduce Disparities in End of Life Care (BRiDgE)

7.项目总结/摘要 65岁以上的成年人在种族和族裔方面越来越多样化。尽管 尽管过去二十年来临终关怀的质量有所改善，但仍然存在重大差距。黑色 患者及其家属报告的临终关怀质量较差，更有可能接受无效的治疗， 护理负担重，在生命结束时不太可能参加临终关怀。有效的医患沟通 对于提高临终关怀的质量至关重要。美国的医生主要是白色和亚洲人 美国，不太可能讨论临终关怀和显示较差的沟通方式与黑人患者。 内隐偏见是指无意识的、自动的态度或刻板印象。医生隐含的种族偏见是 在某些临床情况下广泛存在并与沟通行为相关。这种偏见对 在临终环境中的沟通还没有被研究。 建议的教学法和指导临床研究的结合将使庄博士建立 她现有的定量和定性的技能，通过设计模拟病人接触的措施， 沟通行为，发展社区参与研究的专业知识，并开展临床试验。 指导调查将在三名资深调查员的指导下进行，这些调查员具有严重的 疾病沟通、健康差异和社区参与研究以及姑息治疗。具体 目的：1）测试内隐偏见和刻板印象对临床医生沟通行为的影响，2） 确定对面临严重疾病的黑人患者最重要的临终沟通要素， 城市社区，以及3）评估生命终结的可行性，可接受性和潜在功效 沟通培训干预临床医生，以减轻隐性偏见和刻板印象的影响。 庄博士将评估内隐偏见，刻板印象和沟通之间的关系， 模拟设置使用验证措施的内隐偏见和沟通行为。她将获得 来自医生关于他们的沟通和隐式偏见培训需求和偏好的反馈。她将 设计、实施和分析深入的照顾者焦点小组访谈，为主要干预措施提供信息。 最后，她将设计和实施一个内隐偏见和刻板印象的缓解和沟通技巧 对医生进行培训干预，包括基于证据的偏倚缓解技术和护理人员 输入，将在一项小型随机对照试验中进行试点。这将直接为R-01奠定基础 申请多中心随机对照试验，以测试干预如何导致患者的变化- 以家庭为中心的结果以及临床和医疗保健利用结果。这种先进的训练 定性和定量的方法将产生一个自信的病人为导向的健康差距研究者。

7. Project Summary/Abstract The population of adults over 65 is becoming more racially and ethnically diverse. Despite improvements in the quality of end-of-life care over the past two decades, significant disparities remain. Black patients and their families report poorer quality end-of-life care, are more likely to receive ineffective and burdensome care and are less likely to enroll in hospice at end of life. Effective patient-doctor communication is crucial for improving the quality of end-of-life care. Physicians, who are mainly White and Asian in the United States, are less likely to discuss end-of-life care and display poorer communication styles with Black patients. Implicit bias refers to unconscious, automatic attitudes or stereotypes. Physician implicit racial bias is widespread and associated with communication behavior in some clinical situations. The effects of this bias on communication in the end-of-life setting have not been studied. The proposed combination of didactics and mentored clinical investigation will allow Dr. Chuang to build on her existing quantitative and qualitative skills by designing simulated patient encounter measures of communication behavior, developing expertise in community engaged research, and developing a clinical trial. Mentored investigation will occur under the instruction of three senior investigators with expertise in serious illness communication, health disparities and community engaged research, and palliative care. The specific aims include: 1) to test the impact of implicit bias and stereotyping on clinician communication behaviors, 2) to identify elements of end-of-life communication that are most important to Black patients facing serious illness in an urban community, and 3) to assess the feasibility, acceptability and potential efficacy of an end-of-life communication training intervention for clinicians to mitigate the effects of implicit bias and stereotyping. Dr. Chuang will assess the relationship between implicit bias, stereotyping and communication in a simulated setting using validated measures of implicit bias and communication behaviors. She will obtain feedback from physicians on their communication and implicit bias training needs and preferences. She will design, implement and analyze in-depth caregiver focus group interviews to inform the main intervention. Finally, she will design and implement an implicit bias and stereotyping mitigation and communication skills training intervention for physicians incorporating evidence-based bias mitigation techniques and caregiver input, which will be piloted in a small randomized controlled trial. This will directly lay the foundation for an R-01 application for a multi-site randomized controlled trial to test how the intervention leads to changes in patient- and family-centered outcomes as well as clinical and healthcare utilization outcomes. This training in advanced qualitative and quantitative methods will produce a confident patient-oriented health disparities researcher.