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首页> 外文期刊>Journal of palliative medicine >Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol
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Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol

机译：通过改进的提前关怀规划减少老年非裔美国人姑息治疗质量的差异：研究设计和协议

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Advance care planning (ACP) improves end-of-life care for patients and their caregivers. However, only one-third of adults have participated in ACP and rates are substantially lower among African Americans than among whites. Importantly, ACP improves many domains of care where there are racial disparities in outcomes, including receipt of goal-concordant care, hospice use, and provider communication. Yet, few studies have examined the effectiveness of ACP interventions among African Americans. The objectives of reducing disparities in the quality of palliative care for older African Americans through improved advance care planning (EQUAL ACP) are as follows: to compare the effectiveness of two interventions in (1) increasing ACP among African Americans and whites and (2) reducing racial disparities in both ACP and end-of-life care; and to examine whether racial concordance of the interventionist and patient is associated with ACP. EQUAL ACP is a longitudinal, multisite, cluster randomized trial and a qualitative study describing the ACP experience of participants. The study will include 800 adults >= 65 years of age (half African American and half white) from 10 primary care clinics in the South. Eligible patients have a serious illness (advanced cancer, heart failure, lung disease, etc.), disability in activities of daily living, or recent hospitalization. Patients are followed for one year and participate in either a patient-guided, self-management ACP approach, including a Five Wishes form or structured ACP with Respecting Choices First Steps. The primary outcome is formal or informal ACP-completion of advance directives, documented discussions with clinicians, and other written or verbal communication with surrogate decision makers about care preferences. Secondary outcomes assessed through after-death interviews with surrogates of patients who die during the study include receipt of goal-concordant care, health services use in the last year of life, and satisfaction with care. EQUAL ACP is the first large study to assess which strategies are most effective at both increasing rates of ACP and promoting equitable palliative care outcomes for seriously ill African Americans.
机译：先进的护理计划（ACP）改善患者及其护理人员的生活结束护理。但是，只有三分之一的成年人参加了ACP和税率在非洲裔美国人中的率明显低于白人。重要的是，ACP改善了许多护理领域，其中成果中存在种族差异，包括接收目标 - 协调式护理，临终关怀和提供商沟通。然而，很少有研究已经检查了非洲裔美国人之间ACP干预的有效性。通过改进的提前护理计划（平等ACP）降低老年非裔美国人姑息治疗质量差异的目标如下：比较（1）增加非洲裔美国人和白人和（2）中的两次干预措施的有效性减少ACP和终生护理中的种族差异;并仔细检查干预案和患者的种族协调是否与ACP相关。等于ACP是一个纵向，多路径，集群随机试验和描述参与者ACP体验的定性研究。该研究将包括800名成人> = 65岁（非洲非洲裔美国人和半白色），来自南部的10个初级保健诊所。符合条件的患者有严重的疾病（晚期癌症，心力衰竭，肺病等），在日常生活活动中的残疾或最近的住院治疗。患者遵循一年并参与患者引导的自我管理的ACP方法，包括五个愿望，尊重选择的ACP是尊重的第一步。主要结果是正式或非正式的ACP - 完成预付款，记录与临床医生的讨论以及与代理决策者的其他书面或口头沟通有关护理偏好。通过死亡患者的替代评估的二次结果，与在该研究期间死亡的患者的代理包括接收目标 - 辅助护理，在生命的最后一年的卫生服务以及与护理的满足感。平等的ACP是第一个评估哪些策略在额外的ACP率和促进严重的非洲裔美国人的持续痛苦护理结果中最有效的大学研究。

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