Understanding and addressing structural racism and its impact on the quality of end-of-life care in older Black adults

理解和解决结构性种族主义及其对老年黑人临终关怀质量的影响

• 批准号: 10704102
• 负责人: Elizabeth Dzeng
• 金额: $ 24.3万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704102
• 关键词: Accountability; Address; Adult; Alabama; American; Area; Asian Americans; Attitude; Award; Black American; Black race; Caring; Clinical; Clinical Trials; Communities; Crows; Development Plans; Discrimination; Economics; Education; Elderly; Empathy; Employment; Ethicists; Face; Failure; Family member; Future; Geriatrics; Goals; Health; Health Services Accessibility; Health system; Healthcare; Hospital Administrators; Hospitalists; Hospitals; Housing; Incentives; Individual; Inequity; Institution; Institutional Racism; International; Intervention; Intervention Studies; Interview; Knowledge; Leadership; Learning; Life Cycle Stages; Life Experience; Methods; Mission; National Institute on Aging; Outcome; Pain management; Palliative Care; Pathway interactions; Perception; Personal Satisfaction; Persons; Police; Policies; Public Health; Racial Equity; Recording of previous events; Research; Research Methodology; Research Personnel; San Francisco; Scholarship; Shapes; Site; Social Environment; Social Justice; Structural Racism; Structure; System; Testing; Training; Universities; Variant; Woman; Work; acceptability and feasibility; anti-racism; career development; clinical care; cohort; community based participatory research; community-level factor; design; driving force; effectiveness/implementation hybrid; end of life; end of life care; experience; feasibility testing; health care disparity; health equity; human centered design; implementation science; improved; innovation; lens; maltreatment; member; multi-component intervention; multidisciplinary; mutual learning; neglect; novel; pragmatic trial; preference; protocol development; racial disparity; racism; skills; sociologist; theories; therapy development; tool

PROJECT SUMMARY/ABSTRACT Black Americans are less likely to receive quality end-of-life (EOL) care in part due to racial disparities in goal- concordant care, inadequate pain treatment, and reduced palliative care access, among others. Despite dec- ades of research documenting racial disparities in EOL care, there has been little progress in rectifying these inequities. This is in part due to a failure to recognize structural racism (e.g. anti-Black discrimination and mis- treatment created and reinforced by multiple societal institutions including education, employment, housing, policing, and healthcare) as a root cause of racial disparities. There is a critical research gap in our under- standing of how structural racism influences racial disparities in the receipt of quality EOL care and interventions to address them. The objective of this Beeson proposal is to understand and address structural racism and its influence on the receipt of quality EOL care in older Black adults. This project's career develop- ment plan will provide Dr. Elizabeth Dzeng with skills and knowledge in CBPR, implementation sciences, clinical trials, leadership in community academic partnerships, structural racism scholarship, geriatrics, and life course perspectives. A Beeson award will enable her to become an independent investigator in understanding and addressing structural racism in EOL care using CBPR and support her long-term goal to become an inter- national research leader in health and racial equity in geriatric palliative care. This study will be conducted at two sites, the San Francisco Bay Area and Birmingham, Alabama, to provide institutional and local variation to enable understanding of the influence of local and institutional histories, policies, and cultures on healthcare. Dr. Dzeng has already been establishing community connections and developing her Community Advisory Board. The first aim of this proposal seeks to understand the lived experiences of structural racism that older Black adults face and how they perceive it influences EOL care. The project's second aim is to understand how structural racism at the institutional and community level drives inequities in the provision of quality EOL care and the barriers and facilitators to institutional change. The third aim is to design, pilot, and determine the ac- ceptability and feasibility of an intervention that adapts a multi-component pathway to hospitals to mitigate structural racism in EOL care. This study is highly innovative because it would be the first study to systemati- cally examine and address structural racism in geriatric palliative care using life course perspectives and CBPR. It uses novel interview methods and CBPR to examine the multi-level factors that contribute to racial inequities in EOL care at a systemic level. This study is significant because it will develop understand at a deeper level of how structural racism impacts end-of-life care and address structural racism through a multi- disciplinary multi-component intervention. This study will inform a future R01 application for a multi-center hy- brid effectiveness-implementation pragmatic trial of an institution-level anti-racism protocol development intervention to mitigate structural racism in EOL care.

项目摘要/摘要 黑人美国人不太可能获得质量终止（EOL）护理，部分原因是目标的种族差异 - 一致的护理，不充分的疼痛治疗以及减少姑息治疗。尽管dec- 记录了EOL护理中种族差异的研究的研究，在纠正这些方面几乎没有进展 不平等。这部分是由于未能识别结构性种族主义（例如，反黑人歧视和错误 由多个社会机构创建和加强的待遇，包括教育，就业，住房， 治安和医疗保健）是种族差异的根本原因。我们的底层存在关键的研究差距 结构性种族主义如何影响种族差异的地位 解决这些问题的干预措施。这个比森建议的目的是了解和解决结构 种族主义及其对年龄较大的黑人成年人获得优质EOL护理的影响。这个项目的职业发展 - MENT计划将为Elizabeth Dzeng博士提供CBPR的技能和知识，实施科学， 临床试验，社区学术伙伴关系的领导力，结构性种族主义奖学金，老年医学和生活 课程观点。 Beeson奖将使她成为理解的独立调查员 并使用CBPR解决EOL护理中的结构性种族主义，并支持她的长期目标 国家健康和种族资产研究领袖老年姑息治疗。这项研究将在 两个地点，分别是旧金山湾地区和阿拉巴马州伯明翰，为机构和地方差异提供 能够理解地方和制度历史，政策和文化对医疗保健的影响。 Dzeng博士已经在建立社区联系并发展她的社区咨询 木板。该提案的第一个目的旨在了解年龄较大的结构种族主义的生活经历 黑人成年人面对的及其感知它如何影响EOL护理。该项目的第二个目的是了解如何 机构和社区层面的结构性种族主义在提供优质的EOL护理方面驱动不平等 以及机构变革的障碍和促进者。第三个目的是设计，驾驶和确定AC- 调整多组分途径的干预措施的可疑性和可行性，以减轻医院 EOL护理中的结构种族主义。这项研究具有很高的创新性 使用生活课程的观点和 CBPR。它使用新颖的访谈方法和CBPR来检查有助于种族的多层次因素 EOL护理中的不平等处于系统性的水平。这项研究很重要，因为它会在 结构性种族主义如何影响临终关怀和通过多种多样的种族主义来解决结构性种族主义的更深层次 纪律多组分干预。这项研究将为未来的R01申请提供多个中心的申请。 机构级反种族主义方案的开发的BRID有效性实践实用试验 干预以减轻EOL护理中的结构性种族主义。