Shared Decision-Making to Reduce Racial Disparities in Oral Anticoagulation Use in Patients with Non-Valvular Atrial Fibrillation

共同决策以减少非瓣膜性心房颤动患者口服抗凝药使用中的种族差异

• 批准号: 10282856
• 负责人: Larry R Jackson
• 金额: $ 16.18万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10282856
• 关键词: Address; Adherence; Adoption; Anticoagulants; Anticoagulation; Arrhythmia; Atrial Fibrillation; Award; Awareness; Benefits and Risks; Biomedical Research; Cardiac; Cardiology; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical; Clinical Trials Design; Communication; Competence; Conflict (Psychology); Consent; Counseling; Data; Decision Making; Development; Diagnosis; Disease; Education; Ensure; Equilibrium; Ethnic group; Evidence based intervention; Faculty; Feedback; Future; Goals; Guidelines; Health system; Healthcare; Heart Abnormalities; Intervention; Interview; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Measures; Medicine; Mentors; Oral; Outcome; Outcome Measure; Patient Preferences; Patient-Centered Care; Patients; Perception; Physicians; Pilot Projects; Primary Care Physician; Primary Health Care; Process; Professional Organizations; Provider; Psychologist; Questionnaires; Race; Randomized Clinical Trials; Research; Research Personnel; Research Proposals; Research Training; Risk; Role; Sampling; Scientist; Stroke; Stroke prevention; Structure; Testing; Therapeutic Intervention; Training; United States; Universities; Work; acceptability and feasibility; base; black patient; care outcomes; career; clinical practice; design; effectiveness testing; efficacy testing; empowered; ethnic minority population; evidence base; experience; feasibility testing; health care delivery; health care disparity; health care quality; health literacy; heart rhythm; implementation science; improved; improved outcome; medical schools; patient oriented; patient-clinician communication; primary outcome; professor; racial and ethnic; racial disparity; racial minority; randomized trial; satisfaction; shared decision making; skills; social; stroke risk; support tools; tool development; uptake; Address; Adherence; Adoption; Anticoagulants; Anticoagulation; Arrhythmia; Atrial Fibrillation; Award; Awareness; Benefits and Risks; Biomedical Research; Cardiac; Cardiology; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical; Clinical Trials Design; Communication; Competence; Conflict (Psychology); Consent; Counseling; Data; Decision Making; Development; Diagnosis; Disease; Education; Ensure; Equilibrium; Ethnic group; Evidence based intervention; Faculty; Feedback; Future; Goals; Guidelines; Health system; Healthcare; Heart Abnormalities; Intervention; Interview; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Measures; Medicine; Mentors; Oral; Outcome; Outcome Measure; Patient Preferences; Patient-Centered Care; Patients; Perception; Physicians; Pilot Projects; Primary Care Physician; Primary Health Care; Process; Professional Organizations; Provider; Psychologist; Questionnaires; Race; Randomized Clinical Trials; Research; Research Personnel; Research Proposals; Research Training; Risk; Role; Sampling; Scientist; Stroke; Stroke prevention; Structure; Testing; Therapeutic Intervention; Training; United States; Universities; Work; acceptability and feasibility; base; black patient; care outcomes; career; clinical practice; design; effectiveness testing; efficacy testing; empowered; ethnic minority population; evidence base; experience; feasibility testing; health care delivery; health care disparity; health care quality; health literacy; heart rhythm; implementation science; improved; improved outcome; medical schools; patient oriented; patient-clinician communication; primary outcome; professor; racial and ethnic; racial disparity; racial minority; randomized trial; satisfaction; shared decision making; skills; social; stroke risk; support tools; tool development; uptake

Blacks with non-valvular atrial fibrillation (NVAF) are less likely to receive oral anticoagulants (OAC) for stroke prevention compared with Whites. This is notable given that Blacks have a 3-fold greater risk of NVAF-related ischemic stroke compared to Whites. My long-term goal is to reduce racial disparities in arrhythmia (defined as an abnormal heart rhythm) care. My goal in applying for a Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research is to acquire the research skills and hands-on experience necessary to become a productive, independent, clinician-scientist. My research focuses on addressing racial disparities in the use of OAC in patients with NVAF. Candidate and Mentors: I am an Assistant Professor of Medicine at Duke University’s School of Medicine where I practice as an cardiac electrophysiologist. My primary mentor, Dr. Kevin Thomas, has expertise in healthcare disparities, specifically the contributors to lower quality of health care delivery and outcomes among racial and ethnic minority populations. Research and Training: The goal of this research proposal is to develop a patient decision support tool aimed at facilitating shared decision making, improving decision quality, and increasing the uptake of OAC in Blacks with NVAF. Shared decision making, aided through the use of patient decision support tools, has been associated with improved outcomes including increased knowledge, less decisional conflict, and increased uptake of therapeutic interventions. Unfortunately, Blacks are more likely to experience non-participatory decision making than non-racial and ethnic minority populations. In this proposal, I will: 1) conduct interviews among Black and White patients with NVAF and clinicians to understand the barriers and facilitators toward participating in shared decision making regarding use of OACs; 2) develop and iteratively evaluate a patient decision support tool; and 3) conduct a pilot study to assess the feasibility and acceptability of a patient decision support tool to facilitate shared decision making. The training plan will prepare me for a career aimed at addressing racial disparities in arrhythmia care and will include education in 1) implementation science to promote the adoption of our patient decision support tool in clinical practice; 2) accruing skills in the design and testing of patient decision support tools; and 3) design of clinical trials to assess the efficacy of our intervention. This research will provide data to support a R01 proposal to test the efficacy of a patient decision support tool to improve shared decision making, decision quality, and potentially increase the use an adherence of OAC in Blacks in a multisite randomized clinical trial. Summary: The proposed research will lead to the development of a patient decision support tool intervention used to facilitate shared decision making in Blacks with NVAF, improve decision quality, and potentially increase the uptake of OAC in Blacks with NVAF. The K01 Diversity award will support my development into a leader in healthcare disparities research with the goal of promoting patient-centered care by empowering patients to make informed, values- based decisions needed to improve decision quality and potentially reduce racial disparities in arrhythmia care.

非浮力房颤（NVAF）的黑人不太可能接受口服抗凝剂（OAC）进行中风 与白人相比，预防。鉴于黑人的与NVAF相关的风险更大，这一点值得注意 与白人相比，缺血性中风。我的长期目标是减少心律不齐的种族分布（定义为 心律异常）护理。我申请指导职业发展奖以促进的目标 生物医学研究的教师多样性是获得必要的研究技能和动手经验 成为一名富有成效的，独立的临床科学家。我的研究重点是解决赛车分布 在NVAF患者中使用OAC。候选人和导师：我是医学助理教授 杜克大学医学院，我在那里作为心脏电生理学家。我的主要导师博士 凯文·托马斯（Kevin Thomas），在医疗保健分销方面拥有专业知识，特别是降低医疗保健质量的贡献者 种族和少数民族人口的分娩和结果。研究与培训：目标 研究建议是为了开发一种旨在促进共同决策的患者决策支持工具 提高决策质量，并增加NVAF黑人的OAC吸收。共同的决策， 通过使用患者决策支持工具有助于 知识增加，决策冲突较少，并增加了热干预措施的吸收。很遗憾， 与非种族和少数民族相比，黑人更有可能经历非参与性决策 人群。在此提案中，我将：1）在NVAF和 临床医生了解障碍和促进者参与有关使用的共同决策 oacs; 2）开发并迭代评估患者决策支持工具； 3）进行试点研究 评估患者决策支持工具的可行性和可接受性，以促进共同的决策。这 培训计划将使我为旨在解决心律不齐护理中的赛车分配做好准备，并将包括 1）实施科学以促进临床采用我们的患者决策支持工具 实践; 2）在设计和测试患者决策支持工具方面的技能； 3）临床设计 试验以评估我们的干预效率。这项研究将提供数据以支持R01提案以测试 患者决策支持工具的效率改善共同决策，决策质量以及潜在的效率 在多站点随机临床试验中，增加黑人中OAC的使用。摘要：提议 研究将导致患者决策支持工具干预的发展，以促进共享 与NVAF的黑人决策，提高决策质量，并可能增加OAC的吸收 黑人与NVAF。 K01多样性奖将支持我成为医疗保健分销领导者的发展 研究的目的是通过使患者有能力提出知情，价值 - 提高决策质量并有可能减少心律不齐护理中的种族分布所需的基于决策。