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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. 项目总结/文摘