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

针对美洲印第安人的文化响应姑息治疗信息：功效试验

• 批准号: 10709495
• 负责人: Karla Hunter
• 金额: $ 15.85万
• 依托单位: SOUTH DAKOTA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10709495
• 关键词: Address; American Indians; Attention; Awareness; Behavioral; Belief; Caring; Cheyenne; Cognitive; Collaborations; Communication; Communities; Control Groups; Data; Decision Making; Ensure; Exposure to; Family; Feedback; Fellowship Program; Future; General Hospitals; Goals; Great Plains; Guidelines; Health; Health Professional; Health Promotion; Health behavior; Human; Indigenous; Intervention; Investments; Knowledge; Life Experience; Massachusetts; Measures; Methodology; Modeling; Morals; Palliative Care; Participant; Patients; Perception; Persons; Phase; Public Health Practice; Quality of life; Recommendation; Research; Research Personnel; Reservations; Resources; Rural Health; Shapes; South Dakota; Testing; Transportation; Tribes; Trust; Universities; Work; behavioral outcome; burden of illness; community based participatory research; comparison control; cultural values; design; efficacy evaluation; efficacy testing; efficacy trial; end of life; evidence base; experience; health belief; health communication; implementation facilitators; improved; innovation; member; multidisciplinary; programs; public health relevance; randomized trial; transmission process; tribal community; tribal leader; tribal member

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.

姑息治疗是专门的患者/以家庭为中心的护理，旨在减少痛苦和 提高严重疾病患者的生活质量。具有文化响应能力的姑息治疗可以 缓解美国印第安人（AIS）经历的严重疾病，并改善了严重的病情 临终决策。但是，对于严重生病的北部平原AI，特别是 南达科他州（SD），访问和使用具有文化响应式姑息治疗的机会受到严重限制。 为了满足这一需求，我们将组建一个多学科的，由部落驱动的合作团队 由大平原部落领导人卫生委员会组成，活跃的AI社区咨询委员会 以下保留：马萨诸塞州夏安河，玫瑰花蕾和松岭 医院和南达科他州立大学。我们的团队将进行广告系列消息传递 使用叙事作为以文化为中心的健康促进模型（NCHP）创建和 以文化为中心的叙事消息传递，以提高姑息治疗的知识和 鼓励参与者进行有关姑息治疗的正式和非正式沟通。 NCHP模型是一种基于证据的创新方法，以增强AI的知识和 正式和非正式地谈论姑息治疗的意图，因为它为 如何构建以文化为中心的叙事，以确定有效叙事的特征和 叙事来改变认知和行为结果的机制。 在我们项目的第1A阶段中，我们将进行谈话回路，以引起传统的健康叙事。 第1B期，这些叙述将转变为以文化为中心的叙事健康消息传递。 在第2A阶段，我们将进行一项随机试验，以测试NCHP模型的效率 增加了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，我们将确定以文化为中心的障碍和促进者 叙事消息传递运动，以告知未来的可扩展工作。我们的项目的目的是：1）开发 以文化为中心的叙事信息，以促进天生护理； 2）测试培养的效率 - 关于姑息治疗的中心叙事消息； 3）确定促进者和竞选障碍 实施和可持续性。来自该R21的数据将为R01提供证据 与SD中的三个AI部落实施消息干预，以增加姑息治疗 利用率。这项研究的方法和发现的方法也可以用于发展文化 - 不同目标群体的中心消息传递，包括500多个全国认可的部落 美国，以提高AI的信心使用或推荐姑息治疗。