Patient-Provider Communication: CAM Beliefs, Attidudes and Practices

描述(由申请人提供)：Maureen George博士，RN之前从NCCAM获得F31和F32培训资助，以进行定性工作，以确定患有哮喘的非裔美国成年人使用CAM的特征。在回顾她之前提交的K23报告时，评价者指出，该提案的优势包括“强有力的候选人、良好的环境及其对可能产生重大影响的少数族裔的调查”。在这次重新提交的提案中，乔治博士增加了CAM、仪器和统计分析方面的导师，组成了一个真正杰出的跨学科导师团队(护理学、医学和公共卫生)。她的赞助商的声明反映了一个详细和深思熟虑的职业发展计划，其中包括课程工作以及以CAM为重点的研究设计、实施和分析、仪器开发和沟通方面的正式和非正式指导。霍普金斯大学为候选人提供了一个良好的指导、奖学金和研究环境，这将促进候选人在这些领域发展专业知识的短期目标，并将促进候选人成为一名独立的CAM调查员的长期目标。考虑到非洲裔美国患者面临的独特挑战，解决健康差距的重要第一步可能是促进患者与提供者相互理解的战略。因此，在这个项目中，我们提出了三个相互关联的项目。在具体目标1中，我们建议调查那些向医疗服务不足的人群提供护理的提供者的个人CAM信念、态度和做法。在具体目标2中，我们计划开发、测试和改进一种CAM通信辅助工具(工具)，以表征患者源自文化的CAM信念、态度和实践。最后，我们计划测试沟通辅助工具的临床效用，以1)促进患者和提供者对CAM(沟通)的讨论，2)促进关于治疗方案的相互决策(伙伴关系)，以及3)鼓励披露对疾病自我管理的共同取向(一致性)。通过这样做，我们将为以关系为中心的护理提供基础，并帮助提供者获得更大的文化能力。这在少数群体中可能尤其重要，与高加索人和亚洲人相比，他们拥有较高的CAM使用率，但不太可能向他们的提供者告知CAM使用情况，不太可能经历充分的以关系为中心的护理，更有可能经历严重的健康不平等。

DESCRIPTION (provided by applicant): Maureen George PhD, RN previously received F31 and F32 training grants from NCCAM to conduct qualitative work characterizing CAM use by African American adults with asthma. In review of her prior K23 submission, reviewers noted that the strengths of the proposal including "the strong candidate, excellent environment, and its investigation of minorities that may have high impact" In this resubmission, Dr. George adds mentors in CAM, instrumentation and statistical analysis to form a truly outstanding interdisciplinary mentoring team (Nursing, Medicine and Public Health). Her Sponsor's Statement reflects a detailed and thoughtful career development plan that Includes coursework as well as formal and informal mentoring in CAM-focused research design, implementation and analysis, instrument development, and communication. Hopkins provides the Candidate a fertile environment for mentoring, scholarship and research that will foster the Candidate's short-term goal of developing expertise in these areas and will facilitate the Candidate's long-term goal of becoming an independent CAM investigator. Given the unique challenges fading African American patients, an important first step in addressing health disparities may likely be strategies that foster mutual patient-provider understanding. Therefore, in this project we propose three inter-related projects. In Specific Aim 1 we propose to survey providers who deliver care to medically underserved populations regarding their personal CAM beliefs, attitudes and practices. In Specific Aim 2 we plan to develop, test and refine a CAM communication aid (instrument) to characterize patients' culturally-derived CAM beliefs, attitudes and practices. Lastly, we plan to test the clinical utility of the communication aid to 1) promote patient-provider discussions of CAM (communication), 2) foster mutual decision-making regarding treatment options (partnership), and 3) encourage disclosure of shared orientations to disease self-management (concordance). In so doing, we would provide the foundation for relationship-centered care and assist providers to acquire greater cultural competency. This may be especially important in minority populations who, compared to Caucasians and Asians, have high CAM use yet are less likely to inform their providers about CAM use, are less likely to experience adequate relationship-centered care and are more likely to experience profound health inequalities.