Improving primary care providers ability to communicate about patients experiences of racism to improve cardiovascular health: a feasibilitystudy

提高初级保健提供者沟通患者种族主义经历以改善心血管健康的能力：可行性研究

• 批准号: 10375503
• 负责人: Brooke A Cunningham
• 金额: $ 19.75万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10375503
• 关键词: Address; Affect; African American; African American population; Age; Anxiety; Area; Attitude; Behavior; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic; Chronic stress; Clinic Visits; Clinical Research; Clinical Sciences; Communication; Communities; Coping Behavior; Death Rate; Development Plans; Discrimination; Disease Outcome; Emotions; Empathy; Environment; Evidence based intervention; Expectancy; Exposure to; Extramural Activities; Faculty; Family Practice; Feasibility Studies; Feedback; Focus Groups; Fostering; Foundations; Funding; Goals; Health; Health Personnel; Health behavior; Healthcare; Heart failure; Hydrocortisone; Hypertension; Inflammation; Institutes; Intelligence; Internal Medicine; Intervention; Knowledge; Language; Lead; Life Style; Link; Literature; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Motivation; Myocardial Infarction; Not Hispanic or Latino; Outcome; Participant; Patients; Perception; Pharmaceutical Preparations; Physicians; Population Heterogeneity; Positioning Attribute; Preventive care; Process; Production; Provider; Public Health Schools; Publications; Qualitative Methods; Qualitative Research; Questionnaire Designs; Race; Recommendation; Reporting; Research; Research Personnel; Residencies; Risk Factors; Self Efficacy; Smoking; Social support; Standardization; Stress; Structural Racism; Surveys; Testing; Therapeutic; Training; Training Programs; Translational Research; Treatment Efficacy; Trust; Visit; Work; allostatic load; cardiovascular disorder risk; cardiovascular health; care providers; career; career development; community engaged research; concept mapping; cultural competence; efficacy outcomes; efficacy testing; expectation; experience; healthy lifestyle; implementation science; improved; innovation; interest; negative emotional state; pilot test; psychosocial; racial disparity; racial health disparity; racism; randomized trial; risk perception; shared decision making; simulation; skills; social cognitive theory; stressor; theories; tool; willingness

PROJECT SUMMARY / ABSTRACT African Americans (AAs) have the highest age-adjusted death rates from major cardiovascular diseases of all racial groups. Many race-related factors contribute to AAs' high rates of CVD. For example, exposure to interpersonal and structural racism contributes to chronic stress, negative emotional states, and poor health behaviors, which, in turn, lead to adverse cardiovascular outcomes. AAs with racially discordant providers experience poorer interpersonal processes of care (less shared decision-making and psychosocial talk) and report lower levels of trust than AAs with same race providers. The candidate's long-term hypothesis is: inviting AA patients to discuss their experiences of racism visit will strengthen the therapeutic relationship and thereby improve AAs' cardiovascular outcomes. Drawing on social cognitive theory and contact theory, the candidate proposes to develop and test a feasible and acceptable method for health care providers to communicate about racism with AA patients. We focus on US born, non-Hispanic, AA patients, because they have the worst cardiovascular health outcomes, and, as a group, longstanding exposure to racism. For providers, we focus on White residents because (1) most health care providers are White; (2) the literature shows that race-discordant relationships have poorer interpersonal processes of care; (3) residents are actively building their communication skills and responsiveness to diverse populations, and (4) residents may have less entrenched behaviors than practicing physicians. In Aim 1, the candidate will conduct focus groups with AA patients and White residents training in Internal Medicine, Med-Peds, and Family Medicine to identify attitudes about and barriers to discussing racism. Then, in Aim 2, the candidate will develop an intervention to communicate about racism that improves residents' self-efficacy and outcome expectancies, prior to pilot testing the intervention in Aim 3. A community advisory board will advise the candidate throughout the research process. The candidate's long-term career goal is to become an independent investigator who reduces racial disparities by developing innovative evidence-based interventions to address the multiple mechanisms through which racism adversely affects health. The career development plan includes training in advanced qualitative and quantitative methods, community engaged research and concept mapping, communication about racism, implementation science, and clinical research. The candidate has an exceptional team of mentors and advisors who are distinguished scholars in the aforementioned areas. The candidate is well-positioned to conduct this research, which will transition her to independence as an investigator and lay the foundation for a large-scale randomized trial. She has access to a rich academic environment, which includes a department with a strong record of publications and extramural funding, an excellent School of Public Health, a Clinical and Translational Science Institute that invests in junior faculty, and a state-of-the art Simulation Center.

项目概要/摘要 非裔美国人 (AA) 因主要心血管疾病而导致的年龄调整死亡率最高 种族群体。许多与种族相关的因素导致 AA 的高 CVD 发生率。例如，暴露于 人际和结构性种族主义会导致慢性压力、消极情绪状态和健康状况不佳 行为，进而导致不良的心血管结局。 AA 与种族不和谐的提供商 经历较差的人际护理过程（较少共同决策和心理社会谈话）并且 与相同赛事提供商的 AA 相比，其信任度较低。候选人的长期假设是：邀请 AA 患者讨论他们的种族主义访问经历将加强治疗关系，从而 改善 AA 的心血管结局。候选人利用社会认知理论和接触理论 提议开发并测试一种可行且可接受的医疗保健提供者沟通方法 关于 AA 患者的种族歧视。我们专注于美国出生的非西班牙裔 AA 患者，因为他们的情况最糟糕 心血管健康结果，以及作为一个群体长期遭受种族主义的影响。对于供应商来说，我们专注于 白人居民，因为 (1) 大多数医疗保健提供者是白人； (2) 文献表明，种族不和谐 人际关系的人际关怀过程较差； （三）居民积极建设 沟通技巧和对不同人群的反应能力，以及（4）居民可能不太根深蒂固 行为优于执业医师。在目标 1 中，候选人将与 AA 患者进行焦点小组讨论，并 白人住院医生接受内科、医学和家庭医学培训，以了解他们的态度 讨论种族主义的障碍。然后，在目标 2 中，候选人将制定干预措施来沟通 在试点测试干预措施之前，种族主义可以提高居民的自我效能和结果预期 目标 3. 社区咨询委员会将在整个研究过程中为候选人提供建议。这 候选人的长期职业目标是成为一名独立调查员，通过以下方式减少种族差异 制定基于证据的创新干预措施，以解决种族主义的多种机制 对健康产生不利影响。职业发展计划包括高级定性和 定量方法、社区参与研究和概念图、有关种族主义的交流、 实施科学和临床研究。候选人拥有一支出色的导师和顾问团队 他们都是上述领域的杰出学者。候选人有能力进行这项工作 研究，这将使她成为一名独立的调查员，并为大规模的研究奠定基础 随机试验。她拥有丰富的学术环境，其中包括一个拥有强大实力的部门 出版物和校外资助的记录，优秀的公共卫生学院，临床和转化 科学研究所投资于初级教师和最先进的模拟中心。

项目成果

The White Coat: A Counter Narrative.

白大褂：反叙事。

• DOI: 10.1080/15265161.2020.1861366
• 发表时间: 2021
• 期刊: The American journal of bioethics : AJOB
• 作者: Cunningham,Brooke

Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making.

• DOI: 10.1007/s40615-021-01141-1
• 发表时间: 2022-10
• 期刊: Journal of racial and ethnic health disparities
• 影响因子: 3.9
• 作者: Okah E;Thomas J;Westby A;Cunningham B
• 通讯作者: Cunningham B