Targeting Bias to Reduce Disparities in End of Life Care (BRiDgE)

针对偏见减少临终关怀方面的差异 (BRiDgE)

基本信息

批准号：
10490851
负责人：
Elizabeth Chuang
金额：
$ 16.72万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-18 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10490851
关键词：
Address Adult Affect Applications Grants Area Asian Attitude Award Belief Black American Black race Caregivers Caring Clinical Clinical Trials Code Communication Critical Illness Educational Intervention Effectiveness of Interventions Elements Enrollment Failure Family Family Caregiver Family Study Feedback Focus Groups Foundations Funding Goals Group Interviews Healthcare Hospice Care Implicit Association Test Instruction Intervention Investigation Knowledge Link Measures Mentors Methods Minority Groups Modeling Needs Assessment Nonverbal Communication Outcome Palliative Care Participant Patient Preferences Patients Pattern Physicians Population Questionnaires Race Randomized Randomized Controlled Trials Recording of previous events Regrets Reporting Research Research Personnel Research Training Resistance Services Site Stereotyping Techniques Testing Training Trauma Trust Unconscious State United States Urban Community Urban Hospitals Videotape Work arm base black patient care preference career clinical investigation communication behavior community engaged research design disparity reduction distrust effectiveness testing end of life end of life care end-of-life communication ethnic diversity evidence base experience feasibility testing health care disparity health care service utilization health disparity hospice environment implicit bias improved patient oriented patient-clinician communication preference racial and ethnic disparities racial bias racial diversity recruit simulation skills skills training social exclusion tool

项目摘要

7. Project Summary/Abstract The population of adults over 65 is becoming more racially and ethnically diverse. Despite improvements in the quality of end-of-life care over the past two decades, significant disparities remain. Black patients and their families report poorer quality end-of-life care, are more likely to receive ineffective and burdensome care and are less likely to enroll in hospice at end of life. Effective patient-doctor communication is crucial for improving the quality of end-of-life care. Physicians, who are mainly White and Asian in the United States, are less likely to discuss end-of-life care and display poorer communication styles with Black patients. Implicit bias refers to unconscious, automatic attitudes or stereotypes. Physician implicit racial bias is widespread and associated with communication behavior in some clinical situations. The effects of this bias on communication in the end-of-life setting have not been studied. The proposed combination of didactics and mentored clinical investigation will allow Dr. Chuang to build on her existing quantitative and qualitative skills by designing simulated patient encounter measures of communication behavior, developing expertise in community engaged research, and developing a clinical trial. Mentored investigation will occur under the instruction of three senior investigators with expertise in serious illness communication, health disparities and community engaged research, and palliative care. The specific aims include: 1) to test the impact of implicit bias and stereotyping on clinician communication behaviors, 2) to identify elements of end-of-life communication that are most important to Black patients facing serious illness in an urban community, and 3) to assess the feasibility, acceptability and potential efficacy of an end-of-life communication training intervention for clinicians to mitigate the effects of implicit bias and stereotyping. Dr. Chuang will assess the relationship between implicit bias, stereotyping and communication in a simulated setting using validated measures of implicit bias and communication behaviors. She will obtain feedback from physicians on their communication and implicit bias training needs and preferences. She will design, implement and analyze in-depth caregiver focus group interviews to inform the main intervention. Finally, she will design and implement an implicit bias and stereotyping mitigation and communication skills training intervention for physicians incorporating evidence-based bias mitigation techniques and caregiver input, which will be piloted in a small randomized controlled trial. This will directly lay the foundation for an R-01 application for a multi-site randomized controlled trial to test how the intervention leads to changes in patient- and family-centered outcomes as well as clinical and healthcare utilization outcomes. This training in advanced qualitative and quantitative methods will produce a confident patient-oriented health disparities researcher.

7. 项目总结/摘要 65 岁以上成年人口的种族和族裔变得更加多样化。尽管尽管过去二十年临终关怀质量有所提高，但仍存在巨大差距。黑色的患者及其家人报告说，临终关怀质量较差，更有可能接受无效和繁重的护理，并且在临终时不太可能参加临终关怀。有效的医患沟通对于提高临终关怀的质量至关重要。美国的医生主要是白人和亚裔各州不太可能讨论临终关怀，并且与黑人患者的沟通方式也较差。内隐偏见是指无意识、自动的态度或刻板印象。医生隐含的种族偏见是在某些临床情况下广泛存在并与沟通行为相关。这种偏见的影响尚未研究临终环境中的沟通。拟议的教学和指导临床研究的结合将使庄博士能够建立通过设计模拟患者接触测量来评估她现有的定量和定性技能沟通行为、发展社区参与研究的专业知识以及开展临床试验。指导调查将在三名具有严重问题专业知识的高级调查员的指导下进行疾病沟通、健康差异和社区参与研究以及姑息治疗。具体的目标包括：1) 测试隐性偏见和刻板印象对临床医生沟通行为的影响，2) 确定对面临严重疾病的黑人患者最重要的临终沟通要素城市社区，以及 3) 评估临终关怀的可行性、可接受性和潜在功效对临床医生进行沟通培训干预，以减轻隐性偏见和刻板印象的影响。庄博士将评估隐性偏见、刻板印象和沟通之间的关系使用经过验证的隐性偏见和沟通行为测量进行模拟设置。她将获得医生对其沟通和隐性偏见培训需求和偏好的反馈。她会设计、实施和分析深入的护理人员焦点小组访谈，为主要干预措施提供信息。最后，她将设计并实施隐性偏见和刻板印象的缓解和沟通技巧对医生和护理人员进行基于证据的偏见缓解技术和护理人员的培训干预输入，这将在一项小型随机对照试验中进行试点。这将直接为R-01奠定基础申请多中心随机对照试验，以测试干预措施如何导致患者的变化以家庭为中心的结果以及临床和医疗保健利用结果。本次培训进阶定性和定量方法将培养出一位自信的、以患者为导向的健康差异研究人员。