Culturally Responsive Palliative Care Messaging for American Indians: An Efficacy Trial

姑息治疗是以患者/家庭为中心的专门护理，旨在减少患者的痛苦， 提高重病患者的生活质量。文化上敏感的姑息治疗可以 减轻美国印第安人（AI）的严重疾病负担，改善重病AI 生命终结的决策。然而，对于病情严重的北方平原人工智能，特别是那些在 在南达科他州（SD），获得和使用文化上敏感的姑息治疗受到严重限制。 为了满足这一需求，我们将组建一个多学科、部落驱动的协作团队 包括大平原部落领袖健康委员会，活跃的人工智能社区咨询委员会， 以下保留地：夏延河、玫瑰花蕾和松树岭，马萨诸塞州将军 医院和南达科他州州立大学。我们的团队将进行一次宣传活动 功效测试使用叙事作为文化为中心的健康促进模型（NCHP），以创建和 测试以文化为中心的叙事信息，以提高姑息治疗的知识， 鼓励参与者就姑息治疗进行正式和非正式的沟通。 NCHP模型是一种基于证据的创新方法，旨在增强人工智能的知识， 打算正式和非正式地谈论姑息治疗，因为它提供了指导方针， 如何构建以文化为中心的叙事，识别有效叙事的特征， 叙述如何转化认知和行为结果的机制。 在我们项目的第1A阶段，我们将进行谈话圈，以引出传统的健康叙述。在 在第1B阶段，这些叙述将转变为以文化为中心的叙述性健康信息。 在2A期，我们将进行一项随机试验，以测试NCHP模型在以下方面的疗效： 增加AI部落成员的姑息治疗知识和讨论姑息治疗的意图。 在第2B阶段，我们将确定实施以文化为中心的 叙事消息传递活动，为未来的可扩展工作提供信息。我们的目标是：1）发展 以文化为中心的叙事信息，以促进姑息治疗; 2）测试文化的功效- 关于姑息治疗的中心叙事信息; 3）确定活动的促进者和障碍 执行和可持续性。R21的数据将为R 01提供证据， 与SD的三个AI部落实施消息传递干预，以增加姑息治疗 利用率这项研究的方法和结果也可用于发展文化- 针对不同目标群体的中心信息，包括500多个国家认可的部落， 美国，以提高人工智能的信心，使用或推荐姑息治疗。

Palliative care is specialized patient-/family-centered care designed to reduce suffering and enhance quality of life for persons with serious illness. Culturally responsive palliative care can ease serious illness burden experienced by American Indians (AIs) and improve seriously ill AIs end-of-life decision-making. However, for seriously ill Northern Plains AIs, specifically those in South Dakota (SD), access to and use of culturally responsive palliative care is severely limited. To address this need, we will form a multidisciplinary, tribally-driven collaborative team consisting of Great Plains Tribal Leaders Health Board, active AI community advisory boards at the following reservations: Cheyenne River, Rosebud, and Pine Ridge, Massachusetts General Hospital, and South Dakota State University. Our team will conduct a campaign messaging efficacy test using the narrative as culture-centric health promotion model (NCHP) to create and test culture-centric narrative messaging that improves knowledge of palliative care and encourages participants to engage in formal and informal communication about palliative care. The NCHP model is an evidence-based innovative approach to enhance AI’s knowledge and intentions to talk formally and informally about palliative care, because it provides guidelines for how to construct culture-centric narratives which identify the features of effective narratives and the mechanisms by which the narratives work to transform cognitive and behavioral outcomes. In Phase 1A of our project, we will conduct talking circles to elicit traditional health narratives. In Phase 1B, those narratives will be transformed into culture-centric narrative health messaging. In Phase 2A we will conduct a randomized trial to test the efficacy of the NCHP model for increasing AI tribal members’ palliative care knowledge and intentions to discuss palliative care. In Phase 2B, we will identify barriers and facilitators for implementation of the culture-centric narrative messaging campaign to inform future scalable efforts. Our project aims to: 1) develop culture-centric narrative messages to promote palliative care; 2) test the efficacy of culture- centric narrative messaging about palliative care; 3) identify facilitators and barriers to campaign implementation and sustainability. Data from this R21 will provide evidence for an R01 to implement a messaging intervention with three AI tribes in SD, to increase palliative care utilization. The approach of, and findings from, this study can also be used to develop culture- centric messaging for different target groups, including the 500+ nationally recognized tribes in the US, to improve AI's confidence using or recommending palliative care.