Racial inequities in end-of-life healthcare: how perceived discrimination affects communication and decision-making during serious illness

临终医疗保健中的种族不平等：感知到的歧视如何影响严重疾病期间的沟通和决策

• 批准号: 10618971
• 负责人: Crystal Elizabeth Brown
• 金额: $ 16.08万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-23 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10618971
• 关键词: Acute; Admission activity; Advance Care Planning; Affect; Behavior; Cardiopulmonary Resuscitation; Caring; Chronic; Clinical Research; Communication; Critical Care; Data; Decision Making; Development Plans; Disadvantaged; Discrimination; Disparity; Distress; Environment; Ethnic Origin; Event; Funding; Goals; Health Care Costs; Health Professional; Health system; Healthcare; Home; Hospitalization; Hospitals; Incidence; Individual; Inequity; Institute of Medicine (U.S.); Intensive Care Units; Intervention; Intervention Studies; Intervention Trial; Interview; Knowledge; Life; Lung; Measures; Mediating; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Minority; Outcome; Palliative Care; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Physicians; Process; Prospective Studies; Prospective cohort; Public Health Schools; Publications; Qualitative Research; Quality of life; Race; Records; Religious Belief; Reporting; Research; Research Methodology; Research Personnel; Research Training; Resources; Retrospective Studies; Role; Scientist; Sleep; Socioeconomic Status; Stigmatization; Structure; Symptoms; Testing; Time; Training; Trust; Universities; Washington; Work; care outcomes; career development; cohort; collaborative environment; design; education resources; empowerment; end of life; end of life care; ethnic minority; experience; feasibility testing; health care service utilization; health difference; health disparity; implicit bias; improved; insight; intervention refinement; marginalization; member; novel; patient oriented; patient population; patient subsets; patient-clinician communication; perceived discrimination; preference; promote resilience; provider communication; racial difference; racial disparity; racial health disparity; racial minority; randomized trial; resilience; shared decision making; skills; social epidemiology; social health determinants; socioeconomic disadvantage; stress management; success; theories; therapy development; translational health science

Project Summary/Abstract Candidate: This K23 award will provide an opportunity for Dr. Brown to transition to an independently funded physician scientist with a focus on reducing and eliminating inequities in serious illness. This project builds on her previous work investigating disparities in communication and palliative care, and examining associations between socioeconomic status, race/ethnicity, and healthcare utilization at the end of life. Dr. Brown will attain expertise in research methods in health disparities and social determinants of health, creating and maintaining a cohort, advanced qualitative research methods, and refinement and implementation of a pilot randomized trial. This will occur through an integrated career development plan consisting of coursework, mentorship from highly accomplished and skilled independent researchers, and protected time to gain practical research experience. Environment: The University of Washington (UW) provides a rich academic environment and a broad range of educational and research resources including: the UW Division of Pulmonary, Critical Care, and Sleep Medicine Clinical Research Training Track, which provides a collegial and collaborative environment; the Cambia Palliative Care Center of Excellence; the School of Public Health; and the Institute of Translational Health Sciences. Dr. Brown has assembled a mentoring team with expertise in outcomes and social epidemiology, strong records of funding and publication, and success in training early-investigators. Research: This proposal outlines a mixed methods study with the following goals: 1) understand the associations between perceived discrimination, mistrust, communication, and healthcare intensity at the end of life; 2) elicit perspectives of marginalized patients who endorse experiencing healthcare discrimination and how this affects patient-clinician communication and healthcare decision-making during serious illness; and 3) perform a pilot randomized trial of an intervention to improve resilience and facilitate communication skills in patients who endorse experiencing discrimination from healthcare professionals. Dr. Brown will create and maintain a prospective cohort of patients with serious illness to investigate the relationships between perceived discrimination, mistrust, communication, and healthcare outcomes. Next, she will conduct semi-structured interviews with a sub-group of patients from this cohort and use modified grounded theory methods to understand patients' perspectives of the role of discrimination on communication and decision-making. Lastly, she will perform a pilot randomized trial of an established intervention (Promoting Resilience in Stress Management) to improve resilience and help facilitate goal-making and communication skills in patients who have experienced healthcare discrimination. Understanding how perceived discrimination affects communication and decision- making in serious illness will help contribute toward reducing inequities in the care of minorities with serious illness and other vulnerable patient populations.

项目总结/摘要 候选人：这个K23奖将为布朗博士提供一个机会，过渡到一个独立资助的 医生科学家，重点是减少和消除严重疾病的不平等。该项目建立在 她以前的工作是调查沟通和姑息治疗方面的差异， 社会经济地位，种族/民族和生命末期的医疗保健利用之间的关系。布朗博士将获得 在健康差异和健康的社会决定因素的研究方法方面的专门知识， 一个队列，先进的定性研究方法，完善和实施试点随机试验。 这将通过一个综合的职业发展计划来实现，该计划包括课程作业、 完成和熟练的独立研究人员，并保护时间，以获得实际的研究经验。 环境：华盛顿大学（UW）提供了丰富的学术环境和广泛的 教育和研究资源，包括：肺，重症监护和睡眠的UW部门 医学临床研究培训轨道，它提供了一个学院和协作的环境;坎比亚 卓越的姑息治疗中心;公共卫生学院;和转化健康研究所 以理工科为重布朗博士组建了一个具有成果和社会流行病学专业知识的指导团队， 在资助和出版方面有着良好的记录，在培训早期研究人员方面也取得了成功。 研究：该提案概述了一项混合方法研究，其目标如下：1）了解 感知到的歧视，不信任，沟通和医疗保健强度之间的关联 生活; 2）引出支持经历医疗歧视的边缘化患者的观点，以及如何 这会影响严重疾病期间的患者-临床医生沟通和医疗保健决策;以及3） 进行一项干预措施的试点随机试验，以提高复原力和促进沟通技能， 那些赞同遭受医疗保健专业人员歧视的患者。布朗博士将创建和 维持一个严重疾病患者的前瞻性队列，以调查感知的 歧视、不信任、沟通和医疗结果。接下来，她将进行半结构化的 与来自该队列的一个亚组患者进行访谈，并使用修改的扎根理论方法来了解 患者对歧视在沟通和决策中的作用的看法。最后，她将 进行一项既定干预措施的试点随机试验（促进压力管理中的恢复力）， 提高患者的适应能力，帮助患者制定目标和沟通技巧， 医疗歧视。了解感知到的歧视如何影响沟通和决策- 使在严重疾病将有助于减少不公平的照顾少数民族与严重 疾病和其他弱势患者群体。