Understanding and addressing structural racism and its impact on the quality of end-of-life care in older Black adults

项目总结/摘要 美国黑人不太可能获得高质量的临终关怀（EOL），部分原因是种族差异的目标- 协调护理、疼痛治疗不足和姑息治疗机会减少等。尽管dec- 大量的研究记录了终末期护理中的种族差异，但在纠正这些差异方面几乎没有进展。 不平等这部分是由于未能认识到结构性种族主义（如反黑人歧视和错误的种族主义）。 教育、就业、住房等多个社会机构创造和加强的待遇， 警察和医疗保健）作为种族差异的根源。在我们的研究中有一个关键的空白- 结构性种族主义如何影响在接受高质量终末期护理方面的种族差异， 采取干预措施来解决这些问题。本Beeson提案的目的是了解和解决结构性问题， 种族主义及其对老年黑人接受高质量终末期护理的影响。这个项目的职业发展- 项目计划将为Elizabeth Dzeng博士提供CBPR，实施科学， 临床试验，社区学术合作伙伴关系的领导，结构性种族主义奖学金，老年医学和生活 课程前景比森奖将使她成为一个独立的调查员，在了解 并使用CBPR解决EOL护理中的结构性种族主义，并支持她成为一名跨部门的 国家研究领导人在健康和种族平等的老年姑息治疗。本研究将在 两个地点，旧金山弗朗西斯科湾区和伯明翰，亚拉巴马，提供制度和当地的变化， 了解当地和机构历史，政策和文化对医疗保健的影响。 博士Dzeng已经建立了社区联系并发展了她的社区咨询 纸板.这项建议的第一个目的是试图了解结构性种族主义的生活经验， 黑人成年人面临的问题以及他们如何看待它影响了EOL护理。该项目的第二个目标是了解 机构和社区层面的结构性种族主义导致提供优质终末期护理方面的不平等 以及制度变革的障碍和促进因素。第三个目标是设计，试点，并确定交流- 一种干预措施的可接受性和可行性，这种干预措施适用于医院， 结构性种族主义在EOL护理。这项研究具有很大的创新性，因为它将是第一个系统化的研究- 利用生命历程的观点，彻底审查和解决老年姑息治疗中的结构性种族主义问题， CBPR。它使用新颖的访谈方法和CBPR来研究导致种族歧视的多层次因素。 在系统层面上的EOL护理不公平。这项研究是有意义的，因为它将发展理解在一个 更深层次地了解结构性种族主义如何影响临终关怀， 多学科综合干预。本研究将为未来的R 01申请提供信息，用于多中心hy- 在机构一级制定反种族主义议定书的有效性和执行之间建立桥梁 采取干预措施，减轻临终关怀中的结构性种族主义。

PROJECT SUMMARY/ABSTRACT Black Americans are less likely to receive quality end-of-life (EOL) care in part due to racial disparities in goal- concordant care, inadequate pain treatment, and reduced palliative care access, among others. Despite dec- ades of research documenting racial disparities in EOL care, there has been little progress in rectifying these inequities. This is in part due to a failure to recognize structural racism (e.g. anti-Black discrimination and mis- treatment created and reinforced by multiple societal institutions including education, employment, housing, policing, and healthcare) as a root cause of racial disparities. There is a critical research gap in our under- standing of how structural racism influences racial disparities in the receipt of quality EOL care and interventions to address them. The objective of this Beeson proposal is to understand and address structural racism and its influence on the receipt of quality EOL care in older Black adults. This project's career develop- ment plan will provide Dr. Elizabeth Dzeng with skills and knowledge in CBPR, implementation sciences, clinical trials, leadership in community academic partnerships, structural racism scholarship, geriatrics, and life course perspectives. A Beeson award will enable her to become an independent investigator in understanding and addressing structural racism in EOL care using CBPR and support her long-term goal to become an inter- national research leader in health and racial equity in geriatric palliative care. This study will be conducted at two sites, the San Francisco Bay Area and Birmingham, Alabama, to provide institutional and local variation to enable understanding of the influence of local and institutional histories, policies, and cultures on healthcare. Dr. Dzeng has already been establishing community connections and developing her Community Advisory Board. The first aim of this proposal seeks to understand the lived experiences of structural racism that older Black adults face and how they perceive it influences EOL care. The project's second aim is to understand how structural racism at the institutional and community level drives inequities in the provision of quality EOL care and the barriers and facilitators to institutional change. The third aim is to design, pilot, and determine the ac- ceptability and feasibility of an intervention that adapts a multi-component pathway to hospitals to mitigate structural racism in EOL care. This study is highly innovative because it would be the first study to systemati- cally examine and address structural racism in geriatric palliative care using life course perspectives and CBPR. It uses novel interview methods and CBPR to examine the multi-level factors that contribute to racial inequities in EOL care at a systemic level. This study is significant because it will develop understand at a deeper level of how structural racism impacts end-of-life care and address structural racism through a multi- disciplinary multi-component intervention. This study will inform a future R01 application for a multi-center hy- brid effectiveness-implementation pragmatic trial of an institution-level anti-racism protocol development intervention to mitigate structural racism in EOL care.