Racial disparities in shared decision making for patients with acute respiratory failure

项目总结/文摘

PROJECT SUMMARY/ABSTRACT The care of critically ill patients with acute respiratory failure (ARF) involves life-or-death decisions. Ideally, intensive care unit (ICU) clinicians should include patients or their families in shared decision making, which promotes goal-concordant care, reduces psychological distress for both families and clinicians, and shortens ICU length of stay. However, racial disparities have been documented in all components of shared decision making and its associated outcomes. In outpatient settings, clinicians treat Black patients differently from White patients, providing fewer treatment options, less prognostic information, and less emotional support, and making assumptions about rather than eliciting patient preferences. Racial disparities in shared decision making are likely to be amplified in the ICU because clinicians often do not have long-standing relationships with families, and decisions are time-pressured and highly emotional. To promote equitable ICU care, we must fill two critical knowledge gaps: (1) we do not fully understand how or why ICU clinicians differently engage Black and White families in shared decision making about ARF, therefore (2) we do not know how to develop a shared decision making intervention to reduce racial disparities in SDM for patients with ARF. To address these evidence gaps, I propose three specific aims: (1) Compare how ICU physicians engage Black and White families of patients with ARF in decision making using mixed methods to analyze existing transcripts of ICU physician-family meetings; (2) Elicit family and ICU physician experiences with decision making about ARF through focus groups and interviews to identify ICU physician-level barriers to shared decision making with Black families; and (3) Use a human-centered design approach that is guided by feedback from families and ICU physicians to adapt and feasibility test an existing shared decision making intervention (“Jumpstart”) in order to mitigate racial disparities for patients with ARF and their families. This work addresses a key NHLBI priority to “better integrate palliative care concepts, such as respect for treatment preferences, in the management of patients” with acute respiratory failure. I will be supported by the robust research environment at Duke University and an interdisciplinary team of dedicated, nationally respected mentors: Drs. Christopher Cox, Kimberly Johnson, Sharron Docherty, and Meeta Kerlin. At the completion of the proposed project, I will have developed key scientific skills in clinical trials, health disparities research, mixed methods research, and intervention development. I will also collect preliminary data necessary for a follow-up R01 Award to conduct a clinical trial of the adapted intervention. In sum, this K23 Award is critical to my career development, and the results will have a substantial public health impact by promoting equitable shared decision making for patients with acute respiratory failure and their families.