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

姑息治疗是专门的以病人/家庭为中心的护理，旨在减少痛苦和 提高重病患者的生活质量。响应文化的姑息治疗可以 减轻美国印第安人(AIS)的重病负担，改善重病AIS 生命终结决策。然而，对于病情严重的北部平原人工智能，特别是那些 在南达科他州(南达科他州)，获得和使用响应文化的姑息治疗的机会和使用受到严重限制。 为了满足这一需求，我们将组成一个多学科的、由部落驱动的协作团队 由大平原部落首领健康委员会、活跃的人工智能社区咨询委员会组成 以下保留地：夏延河、玫瑰花蕾和松岭，马萨诸塞州总医院 医院和南达科他州立大学。我们的团队将开展一项宣传活动 功效检验采用叙事作为文化中心的健康促进模式(NCHP)来创建和 测试以文化为中心的叙事消息，提高姑息治疗和 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和 打算正式和非正式地谈论姑息治疗，因为它为 如何构建以文化为中心的叙事，以识别有效叙事的特征，并 叙事改变认知和行为结果的机制。 在我们项目的第1A阶段，我们将进行讨论圈，以引出传统的健康叙事。在……里面 在1B阶段，这些叙述将转变为以文化为中心的保健信息叙述。 在第2A阶段，我们将进行一项随机试验，以测试NCHP模型对 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2B阶段，我们将确定实施以文化为中心的 为未来可扩展的工作提供信息的叙述性消息传递活动。我们的项目目标是：1)发展 以文化为中心的叙事信息，以促进姑息治疗；2)测试文化的有效性- 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 实施和可持续性。此R21的数据将为R01提供证据 与SD的三个AI部落一起实施消息干预，以增加姑息治疗 利用率。这项研究的方法和结果也可以用来发展文化- 针对不同目标群体的集中消息传递，包括#年全国认可的500个部落 美国，使用或建议姑息治疗来提高人工智能的信心。

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.