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.

项目概要/摘要 美国黑人不太可能接受优质的临终关怀 (EOL)，部分原因是目标方面的种族差异。 协调护理、疼痛治疗不足以及姑息治疗机会减少等。尽管 dec- 大量研究记录了临终关怀中的种族差异，但在纠正这些问题方面进展甚微 不平等。这部分是由于未能认识到结构性种族主义（例如反黑人歧视和误解）。 由多个社会机构创造和强化的待遇，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。我们的研究存在着严重的差距 结构性种族主义如何影响接受优质 EOL 护理方面的种族差异的立场 采取干预措施来解决这些问题。 Beeson 提案的目标是理解并解决结构性问题 种族主义及其对老年黑人接受优质 EOL 护理的影响。该项目的职业发展—— 医疗计划将为 Elizabeth Dzeng 博士提供 CBPR、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、老年病学和生活 课程观点。比森奖将使她能够成为一名独立调查员，了解 并利用 CBPR 解决 EOL 护理中的结构性种族主义问题，并支持她成为一名国际医生的长期目标 老年姑息治疗健康和种族平等方面的国家研究领导者。这项研究将在 旧金山湾区和阿拉巴马州伯明翰两个地点，为 使人们能够了解当地和机构的历史、政策和文化对医疗保健的影响。 Dzeng 博士已经建立了社区联系并开展了社区咨询 木板。该提案的首要目标是了解老年人所经历的结构性种族主义的生活经历。 黑人成年人的面孔以及他们如何看待它影响临终关怀。该项目的第二个目标是了解如何 机构和社区层面的结构性种族主义导致在提供优质 EOL 护理方面的不平等 以及制度变革的障碍和促进因素。第三个目标是设计、试点和确定 采用多成分途径的干预措施的可接受性和可行性，以减轻医院的负担 EOL 护理中的结构性种族主义。这项研究具有高度创新性，因为它将是第一个系统化的研究 使用生命历程的视角仔细检查和解决老年姑息治疗中的结构性种族主义 CBPR。它使用新颖的访谈方法和 CBPR 来研究导致种族歧视的多层次因素。 系统层面的 EOL 护理不平等。这项研究意义重大，因为它将加深对 更深层次地了解结构性种族主义如何影响临终关怀并通过多种方式解决结构性种族主义 纪律多方面干预。这项研究将为未来 R01 多中心杂交应用提供信息 机构级反种族主义协议制定的桥梁有效性-实施务实试验 旨在减轻 EOL 护理中的结构性种族主义的干预措施。