Targeting Bias to Reduce Disparities in End of Life Care: Clinician Communication Behavior in Simulated Patient Encounters Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 22
- 试验地点
- 1
- 主要终点
- Verbal Dominance
研究概览
简要总结
This study aims to determine the ways in which clinician implicit racial biases affect clinician communication with family members of patients near the end of life and to test a novel physician training intervention to reduce the effects of implicit racial bias on quality of communication.
Phase 1:
A sample of 50 physicians who care for seriously ill patients, including oncologists, critical care physicians and hospital-based internists will participate in a simulated clinical encounter with a Black standardized family member (actor) of a hypothetical case patient. Measures of implicit and explicit bias will be correlated with verbal and nonverbal communication behavior.
Phase 2:
This is a 2-arm randomized feasibility pilot of an intervention to mitigate the effects of clinician implicit bias on communication behavior. Physicians who treat patients with serious illness including oncologists, critical care physicians and hospital-based internists will be recruited to participate in a communication training session to reduce the effects of implicit bias or a control training session focusing only on communication skills. Their communication behavior will be videotaped during a simulated encounter with a Black standardized family member (actor) of a hypothetical patient with serious illness before and after the training sessions. The communication behavior before and after the training session will be compared between physicians that received the communication skills only intervention versus the physicians that received the communication skills and bias mitigation training.
The primary hypothesis is that physicians who receive both the communication skills and the bias mitigation training will have greater improvements in communication skills with the Black standardized caregiver (actor) compared with those who receive only the communication skills training.
This registration is inclusive of phase 2 only as phase 2 is the clinical trial portion of this research. Phase 1 is not a clinical trial as it was an observational study that did not include an intervention. Phase 1 data was used to inform the structure and analysis of phase 2.
详细描述
Significance
Scope of the problem:
US adults over 65 are more racially diverse than ever, and this trend will continue. The number of older Black Americans is projected to reach 12 million or 12% of older adults by 2060. Although the growth of palliative care has improved the quality of end-of-life care over the past two decades, racial and ethnic minority patients have not fully benefitted from these advances. There are well-documented disparities in access and uptake of palliative care and in the quality and intensity of end-of-life care. These inequalities affect many minority groups, each with its unique history, language and culture that may influence the underlying mechanisms of disparities. The current proposal focuses on Black Americans who experience disparities that are deeply rooted in complex historical and present-day interactions with the health care system.
Mechanisms underlying disparities in quality of end-of-life care
Clinician factors:
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, Outcomes Assessor)
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
- •Practicing physicians
- •Specializes in oncology, critical care, hospitalist medicine, emergency medicine or geriatrics
排除标准
- •Physicians who do not care for seriously ill patients in the hospital at least 10% of their working time.
- •Physicians trained in Hospice and Palliative Medicine.
研究组 & 干预措施
Communication and Bias Mitigation Training
This is a communication training session based on a culturally-based program developed with rural, southern Black patients and families and modified for an urban, northern population. A strategy of bias mitigation successfully used with medical students will be adapted for practicing clinicians using results of phase 1. This strategy is based on transformational learning theory and incorporates critical reflection, guided dialogue, perspective taking exercises, role plays and strategy development. If specific communication behaviors are found related to bias and stereotyping in phase 1, these will be discussed and targeted using these techniques. Otherwise, these techniques will be used to address racial bias generally. The intervention will be incorporated within the communication training session.
干预措施: Communication and Bias Mitigation Training (Behavioral)
Communication Training Only
This is a communication training session based on standard palliative care techniques to listen empathically, share prognostic information and treatment options, elicit patient and family goals and values related to their treatment, and facilitate shared decision-making regarding end-of-life treatment.
干预措施: Communication skills training (Behavioral)
结局指标
主要结局
Verbal Dominance
时间窗: During the intervention, up to 5 hours
Verbal dominance was determined by the ratio of clinician to caregiver speaking time during the encounter, ranging from a minimum of 0 to a maximum of approximately 3. A ratio of \>1 indicates that the clinician dominated the discussion. Ratio of clinician to caregiver speaking times are expressed as decimals and summarized both prior to and following the intervention by study arm.
次要结局
- Encounter Duration(During the intervention, up to 5 hours)
- Verbal Communication(During the intervention, up to 5 hours)
- Modified NAAS Score(Duration of intervention, up to 5 hours)
- Physician Talk Time(During the intervention, up to 5 hours)
- Pauses(During the intervention, up to 5 hours)
- Simultaneous Speech(During the intervention, up to 5 hours)
- Number of Interruptions(During the intervention, up to 5 hours)
- Smiling(During the intervention, up to 5 hours)
- Laughing(During the intervention, up to 5 hours)
- Gesturing(During the intervention, up to 5 hours)
- Nodding(During the intervention, up to 5 hours)
- Eye Contact(During the intervention, up to 5 hours)