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

针对偏见减少临终关怀方面的差异 (BRiDgE)

基本信息

批准号：
10490851
负责人：
Elizabeth Chuang
金额：
$ 16.72万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-18 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10490851
关键词：
Address Adult Affect Applications Grants Area Asian Attitude Award Belief Black American Black race Caregivers Caring Clinical Clinical Trials Code Communication Critical Illness Educational Intervention Effectiveness of Interventions Elements Enrollment Failure Family Family Caregiver Family Study Feedback Focus Groups Foundations Funding Goals Group Interviews Healthcare Hospice Care Implicit Association Test Instruction Intervention Investigation Knowledge Link Measures Mentors Methods Minority Groups Modeling Needs Assessment Nonverbal Communication Outcome Palliative Care Participant Patient Preferences Patients Pattern Physicians Population Questionnaires Race Randomized Randomized Controlled Trials Recording of previous events Regrets Reporting Research Research Personnel Research Training Resistance Services Site Stereotyping Techniques Testing Training Trauma Trust Unconscious State United States Urban Community Urban Hospitals Videotape Work arm base black patient care preference career clinical investigation communication behavior community engaged research design disparity reduction distrust effectiveness testing end of life end of life care end-of-life communication ethnic diversity evidence base experience feasibility testing health care disparity health care service utilization health disparity hospice environment implicit bias improved patient oriented patient-clinician communication preference racial and ethnic disparities racial bias racial diversity recruit simulation skills skills training social exclusion tool

项目摘要

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.

7。项目摘要/摘要 65岁以上的成年人的人口在种族和种族上变得越来越多。尽管在过去的二十年中，寿命终止护理质量的改善，仍然存在很大的差异。黑色的患者及其家人报告说，质量较差的寿命终止护理，更有可能接受无效，并且繁重的护理，不太可能在生命终结时参加临终关怀。有效的患者交流对于提高临终护理的质量至关重要。医生，主要是白人和亚洲人各州不太可能讨论临终关怀，并与黑人患者表现出较差的沟通方式。隐性偏见是指无意识，自动态度或刻板印象。医师隐性种族偏见是在某些临床情况下，普遍存在的交流行为相关。这种偏见对尚未研究在终止环境中的沟通。教学用学和指导的临床研究的拟议组合将使Chuang博士能够建造通过设计模拟的患者遇到的措施，她现有的定量和定性技能沟通行为，在社区参与研究方面发展专业知识，并开发临床试验。指导调查将根据三名具有认真专业知识的高级调查员的指示进行疾病沟通，健康差异和社区参与研究以及姑息治疗。具体目的包括：1）测试隐性偏见和刻板印象对临床医生交流行为的影响，2）确定寿命末沟通的元素，对于面临严重疾病的黑人患者最重要的元素城市社区，以及3）评估寿命终止的可行性，可接受性和潜在功效临床医生的沟通培训干预措施减轻隐性偏见和刻板印象的影响。 Chuang博士将评估一个隐性偏见，刻板印象和交流之间的关系使用经过验证的隐性偏见和通信行为的衡量设置。她会得到医生的沟通和隐性偏见培训需求和偏好的反馈。她会的设计，实施和分析深入的护理人员焦点小组访谈，以告知主要干预措施。最后，她将设计和实施隐性的偏见和刻板印象，缓解和沟通技巧培训培训干预措施，结合了循证偏见缓解技术和护理人员输入将在小型随机对照试验中进行试用。这将直接为R-01奠定基础申请多站点随机对照试验，以测试干预措施如何导致患者的变化以及以家庭为中心的结果以及临床和医疗保健利用结果。这项高级培训定性和定量方法将产生自信的面向患者的健康差异研究者。