Patient-Provider Communication: CAM Beliefs, Attidudes and Practices

描述（由申请人提供）：Maureen George博士，注册护士之前获得了NCCAM的F31和F32培训资助，对非裔美国成人哮喘患者使用CAM进行定性研究。在审查她之前提交的K23时，审稿人注意到该提案的优势包括“强有力的候选人，优秀的环境，以及对可能具有高影响的少数群体的调查”。在这次重新提交的报告中，George博士增加了CAM，仪器和统计分析方面的导师，形成了一个真正杰出的跨学科指导团队（护理，医学和公共卫生）。她的赞助商声明反映了一个详细而周到的职业发展计划，包括课程作业以及在cam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肥沃的指导、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研究者的长期目标。鉴于非洲裔美国患者面临的独特挑战正在消退，解决健康差异的重要第一步可能是采取促进患者与提供者相互理解的策略。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信仰、态度和做法。在具体目标2中，我们计划开发，测试和完善CAM交流辅助（仪器），以表征患者文化衍生的CAM信仰，态度和实践。最后，我们计划测试沟通援助的临床效用：1)促进患者与提供者讨论CAM（沟通），2)促进关于治疗方案的相互决策（伙伴关系），以及3)鼓励披露共同的疾病自我管理取向（一致性）。这样做，我们将为以关系为中心的护理提供基础，并帮助提供者获得更大的文化能力。与白种人和亚洲人相比，这在少数民族人群中可能尤其重要，他们使用较多的辅助手段，但不太可能告知其提供者使用辅助手段，不太可能获得充分的以关系为中心的护理，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.