10 Clinical Trials for Various Conditions
Implicit bias is a form of bias in which a person's automatic and unintentional thoughts of another person or group influence either positively or negatively their behavior or the decisions they make. Studies show that healthcare providers have the same amount of bias as any other person and that it can affect patient care. However, in the emergency room, which is fast-paced and there is a high number of patients, implicit bias may be higher. Therefore, this study will look at emergency care center (ECC) providers' willingness to change their implicit bias behaviors. After, it will provide implicit bias education designed for the ECC to the healthcare providers at SMHCS Sarasota campus and assess whether it improved their willingness to change implicit bias behaviors when compared to the providers in the SMHCS Venice campus who did not receive the education.
This study will follow the ADAPT-ITT model to apply the Prejudice Habit Breaking Intervention (PHBI) to pharmacists who have experience with or are willing to prescribe PrEP. We will first collect qualitative data through focus group discussions guided by the Health Equity Implementation Framework (HEIF) on determinants related to the intervention itself, pharmacists, and the community pharmacy context that may impact implementation of the PHBI. Then, we will use this information to adapt the PHBI in an iterative process involving topic experts, pharmacists, and PrEP users. We will then determine the feasibility, acceptability, and preliminary impact of the adapted PHBI to reduce implicit racial bias.
Healthcare providers' implicit bias has been identified as a contributor to longstanding health inequities via negative impacts on the patient-clinician relationship and biased delivery of high-quality evidence-based practices (EBP). The implementation of any EBP runs the risk of worsening existing health disparities due to inequitable access, delivery, or benefit of the intervention. Clinician bias can be a critical and unaddressed determinant of implementation for any EBP. Although some implicit bias interventions for healthcare providers are emerging, studies have rarely included mental health professionals. In a previously NIMH funded project, our research team iteratively developed a brief (\~45 minutes), interactive online Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for school mental health clinicians with promising preliminary findings. The current study will test the effectiveness of VIBRANT-an implementation strategy for promoting equitable adoption, penetration, fidelity, and sustainment of EBPs. One highly learnable, efficient, and scalable EBP that is particularly well-suited for the education sector is Measurement-Base Care (MBC)-the systematic collection of patient-reported progress data to inform clinical decision-making. The proposed study aims to (1) evaluate VIBRANT's feasibility to promote equitable adoption, penetration, fidelity, and sustainment of MBC, with a validated, brief, interactive online training for MBC; (2) examine VIBRANT's impact on proximal mechanisms of change including clinicians' implicit bias as well as distal youth mental health outcomes (i.e., symptoms and functioning) with Black and Latinx youth, and (3) assess feasibility of research procedures for a future large-scale efficacy trial.
The first aim of this study is to test the efficacy of a real-time provider-based individuation intervention to improve the receipt of high-quality rheumatic disease care among Black/African American and lower socioeconomic status (SES) individuals. The second aim is to determine the effect of the individuation intervention on provider-patient communication, adherence, provider trust and care satisfaction.
The overall goal and theme of the Duke Center for Research to Advance Equity in Healthcare is to reduce racial and ethnic disparities in health through interventions that affect the clinical encounter. To achieve this goal, there is an urgent need for interventions that address implicit bias in healthcare. Implicit bias training is widely used to raise self-awareness and provide self-management tools. The overall objective is to test the hypothesis that implicit bias training for healthcare providers will reduce racial and ethnic disparities in patient- centered care. The proposed project will lay the groundwork for testing that hypothesis by using patient focus groups to garner a deeper understanding of perceptions of implicit bias in the clinical encounter; provider and health system stakeholder semi-structured interviews to inform refinement of the existing implicit bias training at Duke; and perform a pilot study of implicit bias training for providers. At the conclusion of this study, the investigators will have the necessary preliminary data to propose a definitive trial to determine the impact of an implicit bias training intervention for providers on racial and ethnic disparities in patient-centered care. This research will ultimately lead to the delivery of equitable, evidence-based, patient-centered care for all.
This study will examine the impact of training primary care providers (PCPs) in motivational interviewing (MI) using artificial intelligence (AI) to augment the training process. MI is a patient-centered approach to engaging patients in their own care. There will be a control group and two intervention groups, with the intervention groups receiving a different amount of MI training. The hypothesis is that the AI-augmented MI training will result in improved patient outcomes, improved clinician wellbeing, and reduced behavioral manifestation of clinician biases. This mixed-methods project will also collect qualitative data from structured interviews and focus groups with participating PCPs to examine perceived facilitators and barriers to the use of the MI approach in primary care.
The goal of this pilot clinical trial is to evaluate the feasibility and limited effectiveness of a digital, arts-based educational intervention addressing nurse stigma towards perinatal substance use. The main questions it aims to answer are: * What is the the feasibility of delivering the training through an asynchronous, web-based platform? * What is the limited effectiveness of the program on nurse stigma towards perinatal substance use? Participants will access and complete the training, including completion of a perinatal substance use stigma scale at baseline, immediately post, and 1-2 months month later. Participants will also be invited to participate in an interview. Researchers will compare the intervention and control groups to see if the training reduces nurse stigma towards perinatal substance use.
This project-also known as "Accountability for Care through Undoing Racism \& Equity for Moms" or ACURE4Moms-aims to reduce Black-White maternal health disparities using multi-level interventions designed to decrease bias in prenatal care, improve care coordination, and increase social support. ACURE4Moms is a pragmatic 4-arm cluster randomized controlled trial conducted with 40 prenatal practices across North Carolina. Practices will be randomly assigned to receive either: Arm 1 (Standard Care): North Carolina Medicaid Care management for high-risk pregnancies; Arm 2 (Data Accountability and Transparency): North Carolina Medicaid Care Management + Practice-level Data Accountability interventions; Arm 3 (Community-Based Doula Support): North Carolina Medicaid Care Management + Community-Based Doula support intervention for high-risk patients during pregnancy and postpartum; or Arm 4 (Data Accountability and Transparency + Community-Based Doula Support): North Carolina Medicaid Care Management + Both Arms 2 and 3 interventions. During each practice's 2-year intervention period, the practice will initiate prenatal care for \~750 patients (30,000 patients total), whose outcomes the investigators will follow and compare between arms until all these patients have reached 1-year post-delivery.
This will be a prospective, observational, single-center study to evaluate the effect of race and ethnicity on anesthesia provider-patient interactions. The investigators will also attempt to validate a new tool for assessing non-verbal communication during the preanesthesia consult. Masking: 1. Patient 2. Anesthesia providers (attending anesthesiologist and resident or Certified Registered Nurse Anesthetist) The patient and anesthesia provider(s) will not be told that the purpose of the study is to compare provider-patient interactions with minority patients to provider-patient interactions with Caucasian patients. The patient and anesthesia provider will be told that the investigators are conducting a study to evaluate provider-patient communication in the preanesthesia setting. The outcome assessor will be part of the research team. Accordingly, they will not be masked. This is a pilot study void of sample size calculations. The investigators hope to enroll 100-200 patients in the study. While not a randomized study, the investigators hope to achieve a balanced number of minority and Caucasian patients.
Successful policing requires rapid and unbiased decision-making, well-developed emotion regulation skills, and psychological resilience. However, law enforcement officers (LEOs) are frequently exposed to intensive work-related stress and trauma, and consequently, are at elevated risk of adverse mental health outcomes. These mental health issues in turn are some of the primary mechanisms underlying other- and self-directed violence among LEOs. The excessive use of force by LEOs, including unjustified shootings, frequently captures national headlines and is considered by many to be one of the most serious and divisive human rights issues in the United States. Previous research suggests that LEOs can be impacted by various factors when making rapid decisions while using firearms, including a lack of careful consideration of contextual factors and unconscious racial stereotypes. This is especially true when their cognitive and emotional resources are compromised due to factors such as stress. Similarly, key precursors to suicide among LEOs include chronic stress, exposure to trauma, alcohol misuse, and depression. The substantial personal, social, and economic costs of LEO stress, including unjustified shootings and suicide, suggest a clear need for innovative and novel prevention programs to promote well-being and reduce violence. Given its demonstrated impact on many of the precursors to self- and other-directed violence among LEOs, one possible approach is an adapted Mindfulness-Based Stress-Reduction (MBSR) program, developed specifically for LEOs. Therefore, the primary objectives of this proposal are to: (1) assess the feasibility of recruitment, adherence to program intervention, and compliance with assessment instruments, and (2) determine the impact of an adapted MBSR program (Mindfulness-Based Resilience Training; MBRT) on precursors to other- and self-directed violence, and in promoting psychological resilience and emotion regulation among LEOs. There is promising preliminary evidence suggesting that mindfulness is an effective strategy for LEOs to decrease stress and its negative outcomes, enhance resilience and emotion regulation, and ultimately reduce other- and self-directed violence. The proposed project will test the impact of MBRT using a pilot feasibility randomized controlled trial (RCT). This research will generate important information on the feasibility of recruitment, adherence to program intervention, and compliance with assessment instruments, and data obtained through the proposed study will build on the investigators existing work to provide support for a larger RCT examining the efficacy of MBRT in reducing violence.