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

7.项目摘要/摘要 65岁以上的成年人的种族和民族多样性正在变得更加多样化。尽管 在过去二十年中，尽管临终关怀的质量有所改善，但仍然存在着巨大的差距。黑色 患者及其家人报告说，质量较差的临终关怀，更有可能得到无效和 负担重的护理，在生命末期不太可能进入临终关怀。有效的医患沟通 对于提高临终关怀的质量至关重要。医生，他们在美国主要是白人和亚洲人 各州不太可能讨论临终关怀，也不太可能与黑人患者表现出较差的沟通方式。 隐性偏见指的是无意识的、自动的态度或刻板印象。医生隐含的种族偏见是 广泛存在，并与某些临床情况下的沟通行为有关。这种偏见对 还没有对临终关怀环境中的通信进行研究。 拟议的教学和有指导的临床研究的结合将使庄博士能够建立 通过设计模拟患者会诊测量，对她现有的定量和定性技能进行分析 交流行为，在社区参与的研究中发展专业知识，以及开发临床试验。 指导调查将在三名具有严重犯罪专业知识的高级调查人员的指导下进行 疾病传播、健康差距和社区参与的研究，以及姑息治疗。具体的 目的包括：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)测试内隐偏见和刻板印象对临床医生沟通行为的影响 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)评估临终关怀的可行性、可接受性和潜在效果 针对临床医生的沟通培训干预，以减轻内隐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 使用内隐偏见和沟通行为的有效测量来模拟环境。她将获得 来自医生的反馈，关于他们的沟通和隐性偏见培训需求和偏好。她会的 设计、实施和分析深入的照顾者焦点小组访谈，以告知主要干预措施。 最后，她将设计和实施隐性偏见和刻板印象的缓解和沟通技能 对采用循证偏见缓解技术的医生和照顾者的培训干预 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 多点随机对照试验的应用，以测试干预如何导致患者- 和以家庭为中心的结果以及临床和医疗保健利用的结果。这项高级培训 定性和定量的方法将产生一个自信的、以患者为中心的健康差距研究人员。

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.