Reconciling Relationships - An RCT Examining Relational and Clinical Decision-Making Impacts of Intensive, Brief and Control Indigenous Cultural Safety Training Interventions for Health Care Providers
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 58
- 试验地点
- 1
- 主要终点
- Whether or not participant would be recommended as a health care provider to family or friends?
研究概览
简要总结
Despite Canada's relative global affluence, striking Indigenous/non-Indigenous health disparities persist. Following the release of the Truth and Reconciliation Commission of Canada's Final Report, and the publication of the First Peoples, Second Class Treatment report, there has been a growing recognition that the Canadian healthcare system - and the healthcare professional (HCP) - Indigenous patient relationship in particular - is a critical, necessary, and promising juncture for intervention. There has been a significant increase in the number of Indigenous cultural safety trainings for HCP across Canada. However, these programs have yet to be systematically evaluated.
This study will use a randomized parallel group design to understand and compare the effects of an intensive multi-modular Indigenous cultural safety training program (Arm 1); a brief, 2-hour, computer-based training session plus 2 follow-up emails (Arm 2); and primary care-related training program (Arm 3, control) for staff physicians, nurse practitioners, and resident physicians affiliated at large urban academic teaching hospitals in Toronto, Canada. 60 participants will be recruited and randomized into one of the three study arms. Participants will complete a series of surveys and questionnaires at baseline and 9-11 weeks post-intervention that include measures of explicit and implicit race bias.
We predict that the educational intervention in Arm 1 will have the most positive effect, followed by Arm 2 and 3 respectively. We anticipate that the results of this study will help urban hospitals implement Indigenous cultural safety training programs that are beneficial to their staff and ultimately improve the quality of care provided to Indigenous patients across Canada.
详细描述
STUDY PURPOSE AND OBJECTIVES
The purpose of this non-commercial, social equity, randomized control trial is to respond to the Calls for Action of the TRC by contributing to the evidence regarding the effectiveness of intensive and brief Indigenous cultural safety training programming for HCP.
The primary objective of this study is:
- To understand and compare the relational and clinical decision-making impacts of an intensive multi-modular Indigenous cultural safety educational intervention; a brief 2-hour Indigenous race-bias educational intervention; and control intervention (primary care training that is time-attention matched to the intensive intervention) for staff physicians, resident physicians, and nurse practitioners affiliated with a large urban academic teaching hospital in Canada (St. Michael's Hospital).
The secondary objectives of this study are:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Double (Participant, Care Provider)
盲法说明
Participants were not informed of the unannounced Indigenous standardized patient (UISP) visit and thus blinded to this primary outcome measure. UISPs, research and site team members were blinded to participants' study arm allocation with the exception of the study coordinator, who facilitated enrollment in intervention and control training groups
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Physicians, resident physicians, or nurse practitioners
- •Non-Indigenous
- •Affiliated with St. Michael's Hospital in Toronto, Canada
- •Work in the Department of Family Medicine or the Emergency Department from January 2018 until 3 months post completion of training
排除标准
- •Completion of Ontario Indigenous Cultural Safety Program or San'yas Indigenous Cultural Safety Training Program;
- •Indigenous
- •Intend to leave St. Michaels Hospital before 3 month post-intervention window
研究组 & 干预措施
Intensive Intervention ("Big Canoe")
20 participants will be randomly assigned to Arm 1. Participants in Arm 1 ("the Big Canoe") will complete an intensive, multi-modular Indigenous cultural safety education training program that is offered online and led by trained facilitators. The curriculum in Arm 1 was developed by the San'yas Indigenous Cultural Safety Training Program in British Columbia with the support of the Ontario Indigenous Cultural Safety Training Program.
干预措施: Big Canoe (Other)
Brief Intervention ("Little Canoe")
20 participants will be randomly assigned to Arm 2. Participants in Arm 2 ("the Little Canoe") will complete a brief, 2-hour, interactive, computer-based Indigenous race-bias education session that is offered in a computer lab with a researcher present and followed up with 2 reinforcement/reminder emails that ask questions about strategy usage at 6 and 8 weeks after the session. The intervention in Arm 2 is an Indigenous adaption of the Devine et al. (2012) anti-bias habit-breaking intervention.
干预措施: Little Canoe (Other)
Control
20 participants will be randomly assigned to Arm 3. Participants in Arm 3 (control) will complete a primary care-related training program that is time-attention matched to Arm 1 but does not contain any content on anti-bias, anti-oppression, Indigenous peoples, or any content related to the unannounced Indigenous standardized patient encounter.
干预措施: Control (Other)
结局指标
主要结局
Whether or not participant would be recommended as a health care provider to family or friends?
时间窗: 8-10 weeks post-intervention/control
Unannounced Standardized patient answers categorical question: "Would you recommend this health care provider to family and friends?" 4 point Likert scale (1. not recommend; 2. recommend with reservations; 3. recommend; 4. highly recommend. Higher score means better outcome
Mean Adherence to Clinical Standards of Care Scale Score
时间窗: 8-10 weeks post-intervention/control
Unannounced Indigenous Standardized patients will assess adherence of participants to clinical standards of care using developed Adherence to Clinical Standards of Care Scale for NSAID renewal and pain assessment. UISPs to present with acute flare of known ankylosing spondylitis and request NSAID renewal. History of episodic retrosternal chest pain suspicious for NSAID induced gastro-esophageal reflux disease only elicited with a review of the GI side effects of NSAIDS. Min value: 0 Max value: 22 Higher score means better outcome.
Mean Quality of Health Care Provider Relationship and Communication Scale Score
时间窗: 8-10 weeks post-intervention/control
Unannounced Indigenous Standardized patients will assess their experience of provider engagement, communication, and Indigenous cultural safety skills using the newly developed Quality of Health Care Provider Relationship and Communication Scale. Min value: 1 Max value: 5 Higher score means better outcome.
次要结局
- External Motivation to Respond Without Prejudice Scale (EMS)(At baseline and 9-11 weeks post-intervention/control)
- Indigenous Implicit Association Test (IAT) Scores(At baseline and 9-11 weeks post-intervention/control)
- Internal Motivation to Respond Without Prejudice Scale (IMS)(At baseline and 9-11 weeks post-intervention/control)
- Modern Prejudice Attitudes Towards Aboriginals Scale (M-PATAS)(At baseline and 9-11 weeks post-intervention/control)