Racial inequities in end-of-life healthcare: how perceived discrimination affects communication and decision-making during serious illness

项目摘要/摘要 候选人：这个K23奖项将为布朗博士提供一个机会，让他过渡到一个独立资助的 内科科学家，专注于减少和消除严重疾病中的不平等现象。这个项目是建立在 她之前的工作调查了沟通和姑息治疗方面的差异，并研究了 在社会经济地位、种族/民族和生命末期的医疗保健利用之间的关系。布朗博士将达到 在健康差距和健康的社会决定因素、创造和维持方面的研究方法方面的专门知识 队列，先进的定性研究方法，以及试点随机试验的完善和实施。 这将通过一个综合的职业发展计划来实现，该计划包括课程作业、来自Highly 有成就和技能的独立研究人员，并保护获得实际研究经验的时间。 环境：华盛顿大学(UW)提供丰富的学术环境和广泛的 教育和研究资源包括：威斯康星大学肺科、重症监护科和睡眠科 医学临床研究培训赛道，提供一个合作和协作的环境； 姑息治疗卓越中心、公共卫生学院和转化健康研究所 科学。布朗博士组建了一支在结果和社会流行病学方面拥有专业知识的指导团队， 良好的资金和出版记录，以及成功培训早期调查人员。 研究：本提案概述了具有以下目标的混合方法研究：1)了解 知觉的歧视、不信任、沟通与医疗保健强度之间的关系 生活；2)激发支持经历医疗歧视的边缘化患者的观点以及如何 这会影响严重疾病期间患者与临床医生之间的沟通和医疗决策；以及3) 进行干预的试点随机试验，以提高恢复力和促进沟通技能 支持遭受医疗保健专业人员歧视的患者。布朗博士将创造和 维持对严重疾病患者的前瞻性队列，以调查感知到的 歧视、不信任、沟通和医疗保健结果。接下来，她将进行半结构化 采访这一队列中的一组患者，并使用改进的扎根理论方法来理解 患者对歧视在沟通和决策中的作用的看法。最后，她会 对已确定的干预措施(促进压力管理中的弹性)进行试点随机试验，以 提高患者的复原力并帮助促进目标制定和沟通技能 医疗保健歧视。了解感知到的歧视如何影响沟通和决策- 重病将有助于减少对患有严重疾病的少数群体的护理不平等 疾病和其他易受伤害的患者群体。

Project Summary/Abstract Candidate: This K23 award will provide an opportunity for Dr. Brown to transition to an independently funded physician scientist with a focus on reducing and eliminating inequities in serious illness. This project builds on her previous work investigating disparities in communication and palliative care, and examining associations between socioeconomic status, race/ethnicity, and healthcare utilization at the end of life. Dr. Brown will attain expertise in research methods in health disparities and social determinants of health, creating and maintaining a cohort, advanced qualitative research methods, and refinement and implementation of a pilot randomized trial. This will occur through an integrated career development plan consisting of coursework, mentorship from highly accomplished and skilled independent researchers, and protected time to gain practical research experience. Environment: The University of Washington (UW) provides a rich academic environment and a broad range of educational and research resources including: the UW Division of Pulmonary, Critical Care, and Sleep Medicine Clinical Research Training Track, which provides a collegial and collaborative environment; the Cambia Palliative Care Center of Excellence; the School of Public Health; and the Institute of Translational Health Sciences. Dr. Brown has assembled a mentoring team with expertise in outcomes and social epidemiology, strong records of funding and publication, and success in training early-investigators. Research: This proposal outlines a mixed methods study with the following goals: 1) understand the associations between perceived discrimination, mistrust, communication, and healthcare intensity at the end of life; 2) elicit perspectives of marginalized patients who endorse experiencing healthcare discrimination and how this affects patient-clinician communication and healthcare decision-making during serious illness; and 3) perform a pilot randomized trial of an intervention to improve resilience and facilitate communication skills in patients who endorse experiencing discrimination from healthcare professionals. Dr. Brown will create and maintain a prospective cohort of patients with serious illness to investigate the relationships between perceived discrimination, mistrust, communication, and healthcare outcomes. Next, she will conduct semi-structured interviews with a sub-group of patients from this cohort and use modified grounded theory methods to understand patients' perspectives of the role of discrimination on communication and decision-making. Lastly, she will perform a pilot randomized trial of an established intervention (Promoting Resilience in Stress Management) to improve resilience and help facilitate goal-making and communication skills in patients who have experienced healthcare discrimination. Understanding how perceived discrimination affects communication and decision- making in serious illness will help contribute toward reducing inequities in the care of minorities with serious illness and other vulnerable patient populations.