Patient-Provider Communication: CAM Beliefs, Attidudes and Practices

描述（由申请人提供）：Maureen乔治PhD，RN之前接受了NCCAM的F31和F32培训赠款，以开展定性工作，描述非洲裔美国成人哮喘患者使用CAM的特征。在审查她之前提交的K23时，审查人员注意到该提案的优势包括“强有力的候选人，良好的环境，以及对可能具有高影响力的少数民族的调查”在这次重新提交中，乔治博士增加了CAM，仪器和统计分析方面的导师，以形成一个真正优秀的跨学科指导团队（护理，医学和公共卫生）。她的赞助商的声明反映了一个详细和周到的职业发展计划，包括课程以及在CAM为重点的研究设计，实施和分析，仪器开发和通信正式和非正式的辅导。霍普金斯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独立CAM调查员的长期目标。鉴于非洲裔美国人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相互理解的战略。因此，在本项目中，我们提出了三个相互关联的项目。在具体目标1中，我们建议调查向医疗服务不足的人群提供护理的提供者，了解他们的个人CAM信念，态度和做法。在具体目标2中，我们计划开发、测试和完善CAM沟通辅助工具（工具），以表征患者的文化衍生CAM信仰、态度和实践。最后，我们计划测试沟通辅助工具的临床实用性，以1）促进患者-提供者关于CAM的讨论（沟通），2）促进关于治疗方案的共同决策（伙伴关系），3）鼓励披露疾病自我管理的共同方向（一致性）。这样做，我们将为以关系为中心的护理提供基础，并协助提供者获得更大的文化能力。这可能是特别重要的少数民族人口相比，高加索人和亚洲人，有高CAM使用，但不太可能告知他们的供应商CAM使用，不太可能经历足够的关系为中心的护理，更有可能经历深刻的健康不平等。

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.