Shared Decision-Making to Reduce Racial Disparities in Oral Anticoagulation Use in Patients with Non-Valvular Atrial Fibrillation

患有非瓣膜性心房颤动(NVAF)的黑人不太可能接受口服抗凝剂(OAC)治疗中风 与白人相比，预防。值得注意的是，黑人患NVAF相关疾病的风险要高出3倍 与白人相比，缺血性中风。我的长期目标是减少心律失常的种族差异(定义为 不正常的心跳)护理。我申请导师职业发展奖的目标是促进 生物医学研究的教师多样性是获得必要的研究技能和实践经验 成为一名多产的、独立的临床医生兼科学家。我的研究重点是解决中国的种族差距 OAC在NVAF患者中的应用候选人和导师：我是麻省理工学院医学助理教授 杜克大学医学院，在那里我是一名心脏电生理学家。我的主要导师，Dr。 凯文·托马斯在医疗保健差距方面拥有专业知识，尤其是导致医疗保健质量下降的因素 在种族和少数民族人口中的分娩和结果。研究和培训：这一目标 研究建议是开发一个患者决策支持工具，旨在促进共享决策， 改善决策质量，并增加患有NVAF的黑人对OAC的摄取。共同决策， 通过使用患者决策支持工具得到帮助，与改善结果相关，包括 增加知识，减少决策冲突，增加对治疗干预的接受。不幸的是， 黑人比非种族和少数民族更有可能经历非参与性决策 人口。在这项提案中，我将：1)对患有NVAF和NVAF的黑人和白人患者进行访谈 让临床医生了解参与共享使用决策的障碍和促进者 2)开发并反复评估患者决策支持工具；以及3)进行先导研究，以 评估患者决策支持工具的可行性和可接受性，以促进共享决策。这个 培训计划将为我的职业生涯做好准备，旨在解决心律失常护理方面的种族差异，并将包括 1)实施科学教育，以促进我们的患者决策支持工具在临床上的采用 实践；2)积累患者决策支持工具的设计和测试技能；3)临床设计 评估我们干预效果的试验。这项研究将提供数据来支持R01提案进行测试 患者决策支持工具的有效性，以改善共享决策、决策质量和潜在 在一项多点随机临床试验中增加OAC在黑人中的使用和依从性。摘要：建议的 研究将导致开发一种患者决策支持工具干预，用于促进共享 在使用NVAF的黑人中进行决策，提高决策质量，并潜在地增加OAC在 黑人有NVAF。K01多样性奖将支持我发展成为医疗保健差距领域的领导者 研究的目标是通过使患者能够做出知情的、有价值的-来促进以患者为中心的护理 提高决策质量和潜在地减少心律失常护理中的种族差异所需的决策。

Blacks with non-valvular atrial fibrillation (NVAF) are less likely to receive oral anticoagulants (OAC) for stroke prevention compared with Whites. This is notable given that Blacks have a 3-fold greater risk of NVAF-related ischemic stroke compared to Whites. My long-term goal is to reduce racial disparities in arrhythmia (defined as an abnormal heart rhythm) care. My goal in applying for a Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research is to acquire the research skills and hands-on experience necessary to become a productive, independent, clinician-scientist. My research focuses on addressing racial disparities in the use of OAC in patients with NVAF. Candidate and Mentors: I am an Assistant Professor of Medicine at Duke University’s School of Medicine where I practice as an cardiac electrophysiologist. My primary mentor, Dr. Kevin Thomas, has expertise in healthcare disparities, specifically the contributors to lower quality of health care delivery and outcomes among racial and ethnic minority populations. Research and Training: The goal of this research proposal is to develop a patient decision support tool aimed at facilitating shared decision making, improving decision quality, and increasing the uptake of OAC in Blacks with NVAF. Shared decision making, aided through the use of patient decision support tools, has been associated with improved outcomes including increased knowledge, less decisional conflict, and increased uptake of therapeutic interventions. Unfortunately, Blacks are more likely to experience non-participatory decision making than non-racial and ethnic minority populations. In this proposal, I will: 1) conduct interviews among Black and White patients with NVAF and clinicians to understand the barriers and facilitators toward participating in shared decision making regarding use of OACs; 2) develop and iteratively evaluate a patient decision support tool; and 3) conduct a pilot study to assess the feasibility and acceptability of a patient decision support tool to facilitate shared decision making. The training plan will prepare me for a career aimed at addressing racial disparities in arrhythmia care and will include education in 1) implementation science to promote the adoption of our patient decision support tool in clinical practice; 2) accruing skills in the design and testing of patient decision support tools; and 3) design of clinical trials to assess the efficacy of our intervention. This research will provide data to support a R01 proposal to test the efficacy of a patient decision support tool to improve shared decision making, decision quality, and potentially increase the use an adherence of OAC in Blacks in a multisite randomized clinical trial. Summary: The proposed research will lead to the development of a patient decision support tool intervention used to facilitate shared decision making in Blacks with NVAF, improve decision quality, and potentially increase the uptake of OAC in Blacks with NVAF. The K01 Diversity award will support my development into a leader in healthcare disparities research with the goal of promoting patient-centered care by empowering patients to make informed, values- based decisions needed to improve decision quality and potentially reduce racial disparities in arrhythmia care.