Trajectories of Trust Among Patients with Sickle Cell Disease

镰状细胞病患者之间的信任轨迹

• 批准号: 8514706
• 负责人: Carlton Haywood
• 金额: $ 13.53万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-05 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8514706
• 关键词: Acute; Acute Pain; Address; Adherence; Affect; African American; Agreement; Area; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Bioethics; Caring; Clinical; Clinical Research; Communication; Complex; Development; Disease; Disease Outcome; Effectiveness; Environment; Erythrocytes; Funding; Goals; Grant; Health; Health Services; Health Services Research; Healthcare; Hemoglobin; Hereditary Disease; K-Series Research Career Programs; Knowledge; Lead; Mentors; Morbidity - disease rate; Opioid; Outcome; Pain; Pain Research; Pain intensity; Pain management; Patient Self-Report; Patients; Perception; Personal Satisfaction; Physicians; Planet Mars; Population; Provider; Public Health; Publishing; Qualitative Research; Quality of Care; Reporting; Research; Research Methodology; Research Personnel; Role; Scientist; Sickle Cell; Sickle Cell Anemia; Symptoms; Testing; Time; Trust; Universities; Work; career; experience; health care quality; health care service utilization; health related quality of life; improved; interest; longitudinal design; medical schools; mortality; patient population; programs; skills

DESCRIPTION (provided by applicant): The purpose of this career development award is to support Dr. Carlton Haywood Jr. in establishing a research program that seeks to improve the well-being of patients with sickle cell disease (SCD) by improving the quality of health care delivered to this population of patients. This award will facilitate Dr. Haywood's acquisition of additional skills and competencies in the areas of health services research, longitudinal designs, and qualitative research methods that are necessary for accomplishing his career goals. Moreover, the award will allow Dr. Haywood to receive mentoring from leading researchers with a strong track record of mentoring research scientists. The Johns Hopkins University offers an ideal environment for the proposed work, particularly be- cause of its strong Schools of Medicine and Public Health, two comprehensive sickle cell centers, and cadre of established researchers in bioethics, health services research, clinical research, and pain research with strong interests in sickle cell disease. The relationship between SCD patients and the clinicians who care for them is in many instances marred by a "crisis of trust", particularly in regards to the issue of pain management. Many clinicians lack trust in SCD patients' reports of the presence or intensity of pain. Many patients lack trust in the desire of clinicians to promote the patient's best interest. Trust is recognized as an essential component of the patient-clinician relationship, and high levels of patient trust in physicians are associated with positive clinical outcomes. While the lack of trust between SCD patients and their clinicians is well established, the determinants of this lack of trust are not well-understood, nor has its clinical impact been well-described. This gap in knowledge impedes our ability to develop and test behavioral interventions to improve the quality of SCD care. Dr. Haywood's long-term research goal is to understand the ways in which SCD patient and clinician attitudes and behaviors impact health outcomes for the SCD population. The overall research objective of this proposal is to identify factors that influence one important attitude, trust, and to determine the role that trust serves in the realization of health outcomes for SCD patients. The rationale for the proposed research is that a greater understanding of the determinants and outcomes of trust in SCD care will lead to the development of effective clinician and patient behavioral interventions to improve outcomes for this patient population. We will pursue 3 specific aims to accomplish the overall study objectives. We will: 1) Evaluate the determinants of patient trust over time, and assess the impact of longitudinal changes in trust on patient-reported and clinical out- comes; 2) Determine the impact of clinician trust on the outcomes of acute healthcare encounters; and 3) Assess the impact of one specific approach to the provision of pain management (the use of opioid agreements) on SCD patient perceptions of clinician trust. This research is expected to lead to a better understanding of the complex attitudinal and behavioral forces that influence trust and patient outcomes within the SCD patient-clinician relationship, thus guiding the development of behavioral interventions to improve SCD outcomes.

描述（由申请人提供）：该职业发展奖的目的是支持小卡尔顿·海伍德（Carlton Haywood Jr.该奖项将有助于海伍德博士在卫生服务研究，纵向设计和定性研究方法中获得其他技能和能力，这是实现其职业目标所必需的。此外，该奖项将使海伍德博士能够通过指导研究科学家的良好记录获得领先的研究人员的指导。约翰·霍普金斯大学（Johns Hopkins University）为拟议工作提供了理想的环境，尤其是由于其强大的医学和公共卫生学校，两个综合的镰状细胞中心，以及成熟的生物伦理学研究人员的干部，卫生服务研究，临床研究和疼痛研究，对镰状细胞疾病有浓厚的兴趣。在许多情况下，SCD患者与关心他们的临床医生之间的关系受到“信任危机”的破坏，尤其是在疼痛管理问题方面。许多临床医生对SCD患者的疼痛存在或强度的报告缺乏信任。许多患者对临床医生的渴望不信任促进患者的最大利益。信任被认为是患者 - 临床关系的重要组成部分，并且对医师的高度信任水平与阳性临床结果有关。尽管SCD患者与其临床医生之间缺乏信任，但缺乏信任的决定因素并没有得到充分理解，也没有很好地描述其临床影响。知识差距阻碍了我们开发和测试行为干预措施以提高SCD护理质量的能力。海伍德博士的长期研究目标是了解SCD患者和临床医生的态度和行为影响SCD人群的健康状况的方式。该提案的总体研究目标是确定影响一种重要态度，信任的因素，并确定信任在实现SCD患者健康结果中发挥的作用。拟议研究的理由是，对SCD护理信任的决定因素和结果有更深入的了解将导致发展有效的临床医生和患者行为干预措施，以改善该患者人群的结果。我们将追求3个具体目标来实现总体研究目标。我们将：1）评估随着时间的推移，评估患者信任的决定因素，并评估信任纵向变化对患者报告和临床外的影响； 2）确定临床医生信任对急性医疗遭遇结果的影响； 3）评估一种特定方法对提供疼痛管理（使用阿片类药物协议的使用）对SCD患者对临床医生信任的看法的影响。预计这项研究将更好地理解在SCD患者 - 智利关系中影响信任和患者结果的复杂态度和行为能力，从而指导行为干预措施的发展以改善SCD结果。