Culturally tailoring an advance care planning intervention for American Indians

我们研究计划的长期目标是，与美国印第安人和阿拉斯加原住民合作， 社区，测试先进的护理规划（ACP）计划的功效和有效性，旨在 根据他们的临终价值观和信仰而定制的文化。我们的项目建立在20年的合作基础上， 主要调查员之一与参与部落切罗基东部部落之间的关系 印度人，以及其他主要研究者的20年临床经验，作为临终关怀和姑息治疗社会 工人和丧亲协调员和她的让你的愿望关于你（我的方式）干预设计和 研究经验。我们在此应用程序中的目标是在文化上量身定制MY WAY ACP课程， 患者教育指南，采用基于社区的参与性方法，通过定性和定量 社区成员参与的方法，社区咨询委员会和专业咨询委员会。我们 实施研究综合框架为这一方法提供了信息， 为目标人群量身定做的，通常是不合适的。我们对这个项目的理由是，它的成功 完成这项工作将为制定文化定制的《最新军事战略》提供必要的证据 路上了我们的项目有三个具体目标：（1）从文化角度调整MY WAY ACP课程的内容， （2）评估在文化上的可行性， 为切罗基印第安人东部部落量身定制“我的方式”ACP课程和耐心教育指南;以及 (3)检查文化定制的MY WAY ACP课程和患者教育指南的初步成果 有70名切罗基印第安人组成的东部乐队。在这个项目顺利完成后，我们希望 我开发了一种可行的文化定制的我的方式，通过准实验性的等待名单设计显示， 承诺作为一个有效的计划，在自我效能，准备，和ACP完成，增加 促进和减少对非加太的障碍。我们将有能力寻求R 01资金，以支持 随机对照试验的文化定制我的方式，以评估其疗效。重要的是，我们希望 第一批为美国印第安人创建ACP计划的人之一，这将导致与其他人的传播。 美国印第安人以及阿拉斯加社区，以确保所有人都有机会表达和 记录他们的护理愿望。我们的研究结果有望对临床产生长期积极影响， 公共卫生实践在东部乐队的切罗基印第安人和其他土著社区，通过 实施MY WAY ACP课程和患者指南，以应对文化多样性 价值观以及信仰和做法方面的结束生命和死亡在整个印度的国家。

The long-term goal of our research program is to, in collaboration with American Indian and Alaska Native communities, test the efficacy and effectiveness of an advance care planning (ACP) program designed to be culturally-tailored to their end-of-life values and beliefs. Our project builds upon a 20-year collaborative relationship between one of the Principal Investigators and the participating tribe, the Eastern Band of Cherokee Indians, and the other Principal Investigator's 20-year clinical experience as a hospice and palliative care social worker and bereavement coordinator and her Make Your Wishes About You (MY WAY) intervention design and research experience. Our objective in this application is to culturally tailor the MY WAY ACP curriculum and patient education guide using a community-based participatory approach through qualitative and quantitative methods engaging community members, a Community Advisory Board, and a Professional Advisory Board. Our approach is informed by the Consolidated Framework for Implementation Research of how interventions, without tailoring for the target population, are usually a poor fit. Our rationale for this project is that its successful completion will provide the necessary incremental step in developing the evidence for the culturally-tailored MY WAY. Our project has three specific aims: (1) culturally tailor the content of the MY WAY ACP curriculum and patient education guide for the Eastern Band of Cherokee Indians; (2) assess the feasibility of the culturally- tailored MY WAY ACP curriculum and patient education guide with the Eastern Band of Cherokee Indians; and (3) examine preliminary outcomes of the culturally-tailored MY WAY ACP curriculum and patient education guide with 70 Eastern Band of Cherokee Indian members. At the successful completion of this project, we expect to have developed a feasible culturally-tailored MY WAY that through a quasi-experimental waitlist design shows promise as an efficacious program with respect to self-efficacy, readiness, and ACP completion that increases facilitators and decreases barriers to ACP. We will be well-positioned to pursue R01 funding to support a randomized controlled trail of the culturally-tailored MY WAY to assess its efficacy. Importantly, we expect to be among the first to have created an ACP program for American Indians that will lead to dissemination with other American Indian as well as Alaska communities to ensure that all are given the opportunity to express and document their care wishes. Our results can be expected to have a long term positive impact for clinical and public health practice at the Eastern Band of Cherokee Indians and other Native communities through the implementation of the MY WAY ACP curriculum and patient guide that is responsive to the diversity of cultural values as well as beliefs and practices with respect to end-of-life and death across Indian Country.