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

项目摘要/摘要 非洲裔美国人(AA)在所有主要心血管疾病中的年龄调整死亡率最高 种族团体。许多与种族相关的因素导致了AAS的高CVD发生率。例如，接触到 人际关系和结构性种族主义会导致长期的压力、消极的情绪状态和糟糕的健康状况 行为，这反过来又会导致不良的心血管后果。AAS与种族不和谐的供应商 经历较差的人际护理过程(较少分享决策和心理社会谈话)和 报告称，与相同种族提供商的AA相比，信任级别较低。候选人的长期假设是：有吸引力 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AAA的心血管结局。借鉴社会认知理论和接触理论，候选人 建议开发和测试一种可行和可接受的方法，供医疗保健提供者进行沟通 关于再生障碍性贫血患者的种族主义。我们专注于在美国出生的非西班牙裔AA患者，因为他们的病情最严重 心血管健康后果，以及作为一个群体长期暴露于种族主义。对于供应商，我们专注于 白人居民是因为(1)大多数医疗保健提供者是白人；(2)文献显示种族不和谐 人际关系的护理过程较差；(3)居民正在积极地建立他们的 沟通技巧和对不同人群的反应能力，以及(4)居民可能没有那么根深蒂固 而不是执业医生的行为。在目标1中，候选人将与再生障碍性贫血患者和 白人住院医生接受内科、内科和家庭医学方面的培训，以确定对 讨论种族主义的障碍。然后，在目标2中，应试者将制定一项干预措施，以交流 种族主义，改善居民的自我效能感和结果预期，在干预试验之前 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。这个 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距 制定创新的循证干预措施，以解决种族主义通过的多种机制 对健康有不利影响。职业发展计划包括高级、定性和高级培训 量化方法，社区参与的研究和概念图，关于种族主义的交流， 实施科学和临床研究。候选人拥有一支杰出的导师和顾问团队 他们都是上述领域的杰出学者。这位候选人完全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 随机试验。她有一个丰富的学术环境，其中包括一个拥有强大 出版记录和外部资金，一所优秀的公共卫生学院，临床和翻译 投资于初级教员的科学研究所，以及最先进的模拟中心。

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.