Disseminating PCOR findings to Reduce Racial Disparities in Surgical Sterilization

传播 PCOR 研究结果以减少绝育手术中的种族差异

• 批准号: 10650016
• 负责人: ELEANOR Bimla SCHWARZ
• 金额: $ 50万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650016
• 关键词: Disseminating; PCOR; findings; Reduce; Racial

Abstract: This proposal, submitted in response to RFA-HS-22-001, in the priority area of “improving maternal health,” is prompted by long-standing racial and ethnic disparities in use of permanent contraception (historically called “surgical sterilization”). In the US, permanent contraceptive procedures are most commonly performed on women of color, women with chronic conditions such as diabetes, and those residing in rural communities. Although permanent contraception aligns well with some patients’ reproductive life plans, reports that 10% of women regret having undergone these procedures are troubling. These regrets and racial disparities are especially problematic given recent PCOR demonstrating that long-acting reversible contraceptives, such as hormonal IUDs are both more effective and less likely to cause pelvic pain than permanent contraceptive procedures. To disseminate PCOR about the comparative safety and real-world effectiveness of alternatives to permanent contraception, we will adapt the advance care planning (ACP) framework, which has been used to ensure that patients receive medical care when approaching their end of life that aligns with their personal treatment goals. This paradigm is a critical tool for supporting patients in making complex medical decisions, by emphasizing elicitation of values, communication skill building, and shared decision-making. By preparing patients approaching the end of their reproductive life to more effectively communicate to clinicians their personal values, priorities, and treatment goals, we will adapt the ACP model for reproductive life planning (RLP), with input from patients (Aim 1, focus groups) and clinicians (Aim 2, semi-structured interviews). We will then conduct an individual-level randomized clinical trial comparing this approach to disseminating PCOR relevant to discussions of permanent contraception with 300 women who identify as Black or have a chronic condition such as diabetes, and who wish to avoid future pregnancy (Aim 3). In evaluating this intervention, our experienced multi-disciplinary team will carefully examine patient-reported outcomes related to communication and satisfaction with care. We will also rigorously analyze heterogeneity of treatment effects by clinical and patient-level contextual factors to inform the potential need for future refinement of this ACP-RLP paradigm. By increasing equitable access to alternatives to permanent contraception, this project strives to increase the proportion of US women who are using a method of contraception that aligns with their personal preferences and reduce the proportion of individuals who regret having undergone a permanent contraceptive procedure.

摘要： 这项提案是根据RFA-HS-22-001，在“改善产妇健康”这一优先领域提出的， 由于在使用永久避孕措施方面长期存在的种族和民族差异(历史上称为 “外科绝育”)。在美国，永久避孕程序最常见的是在 有色人种妇女、患有糖尿病等慢性病的妇女以及居住在农村社区的妇女。 尽管永久避孕措施与一些患者的生殖生活计划很好地吻合，但报告称，10%的 女性后悔接受了这些手术是令人担忧的。这些遗憾和种族差距是 尤其是考虑到最近的PCOR表明，长效可逆避孕药，如 激素性宫内节育器比永久性避孕药更有效，而且不太可能导致盆腔疼痛 程序。传播PCOR关于替代品的相对安全性和实际有效性的信息 为了实现永久避孕，我们将调整预先护理计划(ACP)框架，该框架已被用于 确保患者在生命接近尾声时得到与其个人相一致的医疗护理 治疗目标。这一范例是支持患者做出复杂医疗决定的关键工具， 通过强调价值观的启发、沟通技能的培养和共同决策。通过准备 即将结束生殖生命的患者，以便更有效地与临床医生沟通 根据个人价值观、优先事项和治疗目标，我们将调整ACP模式以进行生殖生活规划 (RLP)，患者(目标1，焦点小组)和临床医生(目标2，半结构化访谈)的意见。我们会 然后进行个人水平的随机临床试验，比较这种方法在传播PCOR方面的作用 与300名自认为是黑人或患有慢性病的妇女讨论永久避孕有关 糖尿病等疾病，以及希望避免未来怀孕的妇女(目标3)。在评估这一干预措施时，我们 经验丰富的多学科团队将仔细检查患者报告的与沟通相关的结果 对护理的满足感。我们还将严格分析治疗效果的异质性，通过临床和 患者水平的背景因素，以告知未来对这一ACP-RLP范例进行改进的潜在需要。通过 为了增加获得永久避孕替代办法的公平机会，该项目努力增加 使用符合个人喜好的避孕方法的美国女性比例 并减少后悔接受了永久性避孕程序的个人比例。