Disseminating PCOR findings to Reduce Racial Disparities in Surgical Sterilization

传播 PCOR 研究结果以减少绝育手术中的种族差异

• 批准号: 10650016
• 负责人: ELEANOR Bimla SCHWARZ
• 金额: $ 50万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650016
• 关键词: Disseminating; PCOR; findings; Reduce; Racial

Abstract: This proposal, submitted in response to RFA-HS-22-001, in the priority area of “improving maternal health,” is prompted by long-standing racial and ethnic disparities in use of permanent contraception (historically called “surgical sterilization”). In the US, permanent contraceptive procedures are most commonly performed on women of color, women with chronic conditions such as diabetes, and those residing in rural communities. Although permanent contraception aligns well with some patients’ reproductive life plans, reports that 10% of women regret having undergone these procedures are troubling. These regrets and racial disparities are especially problematic given recent PCOR demonstrating that long-acting reversible contraceptives, such as hormonal IUDs are both more effective and less likely to cause pelvic pain than permanent contraceptive procedures. To disseminate PCOR about the comparative safety and real-world effectiveness of alternatives to permanent contraception, we will adapt the advance care planning (ACP) framework, which has been used to ensure that patients receive medical care when approaching their end of life that aligns with their personal treatment goals. This paradigm is a critical tool for supporting patients in making complex medical decisions, by emphasizing elicitation of values, communication skill building, and shared decision-making. By preparing patients approaching the end of their reproductive life to more effectively communicate to clinicians their personal values, priorities, and treatment goals, we will adapt the ACP model for reproductive life planning (RLP), with input from patients (Aim 1, focus groups) and clinicians (Aim 2, semi-structured interviews). We will then conduct an individual-level randomized clinical trial comparing this approach to disseminating PCOR relevant to discussions of permanent contraception with 300 women who identify as Black or have a chronic condition such as diabetes, and who wish to avoid future pregnancy (Aim 3). In evaluating this intervention, our experienced multi-disciplinary team will carefully examine patient-reported outcomes related to communication and satisfaction with care. We will also rigorously analyze heterogeneity of treatment effects by clinical and patient-level contextual factors to inform the potential need for future refinement of this ACP-RLP paradigm. By increasing equitable access to alternatives to permanent contraception, this project strives to increase the proportion of US women who are using a method of contraception that aligns with their personal preferences and reduce the proportion of individuals who regret having undergone a permanent contraceptive procedure.

抽象的： 该提案是根据“改善生产健康”的优先领域提交的，以响应RFA-HS-22-001 长期使用永久避孕的赛车和种族差异（历史上） “手术灭菌”）。在美国，永久性避孕程序最常进行 有色妇女，糖尿病等慢性病的妇女以及居住在农村社区的妇女。 尽管永久避孕与某些患者的生殖生活计划非常吻合，但报告说有10％ 妇女后悔接受了这些程序令人不安。这些遗憾和种族差异是 鉴于最近的PCOR证明了长效可逆避孕药，例如 与永久避孕药相比 程序。传播有关替代方案的比较安全性和现实有效性的PCOR 永久避孕，我们将适应已用来的预先护理计划（ACP）框架 确保患者接近与个人一致的生命终结时获得医疗服务 治疗目标。该范式是支持患者做出复杂医疗决策的关键工具， 通过强调启发价值，沟通技巧和共同的决策。通过准备 接近繁殖生命的终结的患者可以更有效地与临床医生交流 个人价值观，优先事项和治疗目标，我们将适应ACP模型的生殖生活计划 （RLP），有来自患者的投入（AIM 1，焦点小组）和临床医生（AIM 2，半结构化访谈）。我们将 然后进行单个级随机临床试验，将这种方法比较传播PCOR 与300名识别为黑人或具有慢性的女性的永久避孕的讨论有关 糖尿病等疾病，以及希望避免将来怀孕的人（AIM 3）。在评估这项干预时，我们 经验丰富的多学科团队将仔细检查与沟通有关的患者报告的结果 和对护理的满意。我们还将严格分析临床和 患者级别的上下文因素，以告知该ACP-RLP范式将来对未来的细化需求。经过 该项目提高了对永久违反替代方案的公平访问权限，该项目致力于增加 使用一种避孕方法与个人喜好保持一致的美国妇女的比例 并减少后悔执行永久避孕程序的个人的比例。