Community Engagement for Systemic Racism

(AACS Trial)

Recruiting at 3 trial locations

Overseen By Tametria V Heard, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Alabama at Birmingham

Disqualifiers: Hospice care, Paid sitter, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve end-of-life care for African American communities by training clinicians to understand and respect cultural values and preferences. The study uses storytelling videos and training to help medical professionals recognize and manage biases, making care more empathetic and culturally appropriate. It includes African Americans aged 60 and older with serious illnesses like cancer or heart disease, as well as those who have recently lost a loved one. Participants should be English-speaking and able to complete surveys. The program, "AA Communities Speak," facilitates these improvements. As an unphased trial, this study allows participants to contribute to meaningful advancements in culturally sensitive healthcare practices.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that the "Caring for Older African Americans" training program is safe for clinicians?

Research has shown that racism can greatly impact health, especially for African Americans. The "Caring for Older African Americans" program addresses these issues by teaching healthcare providers through stories and training to reduce bias. As this program is not a drug or medical device, specific safety data is unavailable. Instead, it focuses on improving communication and understanding. The program is designed to be helpful and supportive, posing no direct risks to participants. Participants can expect a safe and engaging experience that aims to increase empathy and cultural awareness among healthcare providers. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the African American Communities Speak (AACS) Education Intervention because it aims to address systemic racism in healthcare by directly engaging and educating clinician trainees. Unlike traditional approaches that may not focus specifically on cultural competence, this intervention is designed to enhance communication and understanding between healthcare providers and African American communities. By implementing staggered training times, the intervention allows for a thorough evaluation of its impact on reducing racial biases and improving healthcare outcomes. This innovative approach could lead to more equitable healthcare practices and better patient-provider relationships.

What evidence suggests that the "Caring for Older African Americans" training program could be effective in improving end-of-life care for African Americans?

Research has shown that negative experiences with the healthcare system, such as racism and mistrust, can impact the end-of-life care African Americans receive. Studies have found that storytelling and sharing experiences can address these issues by fostering empathy and understanding among healthcare providers. The "African American Communities Speak" (AACS) Education Intervention is being tested in this trial across different clinician trainee clusters. This program uses community-made videos and training to help doctors and nurses recognize and reduce their biases. The approach aims to enhance communication and provide care that respects cultural differences. By encouraging empathy and addressing biases, the program seeks to improve the quality of end-of-life care for African Americans. ^{6 7 8 9 10}

Who Is on the Research Team?

Jennifer Tjia, MD, MSCE

Principal Investigator

University of Massachusetts, Worcester

Are You a Good Fit for This Trial?

This trial is for African American individuals aged 60 or older, who are non-Hispanic/Latino and speak English. It includes those with serious illnesses like cancer or heart disease, bereaved family members of such patients, and pastors. Participants must have a certain level of cognitive function (Callahan score ≥4) and be able to complete surveys.

Inclusion Criteria

I am a 60+ year old African American who recently lost a loved one and can complete surveys.

I am over 18, speak English, live in a community, and care for someone with a serious illness without pay.

I am a pastor, 18 or older, and identify as African American, White, Non-Hispanic or Latino.

Exclusion Criteria

For Family member eligibility in Aim 3: Cannot be a paid 'sitter'

For Person with serious illness in Aim 1.1: Cannot be receiving hospice care

For Bereaved Family Member in Aim 1.1: Cannot be a paid 'sitter'

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-intervention (Control)

Clinician clusters undergo a pre-intervention period before the training program begins

up to 3 months

Intervention

Clinicians receive the African American Communities Speak (AACS) Education Intervention, including training on culturally concordant care and implicit bias management

Varies by cluster start date

Post-intervention (Exposure)

Clinician clusters undergo a post-intervention period to assess the impact of the training program

up to 3 months

Follow-up

Participants are monitored for the effectiveness of the intervention on therapeutic alliance and goal-concordant care

up to 3 months after intervention

What Are the Treatments Tested in This Trial?

Interventions

• AA Communities Speak

Trial Overview The 'Caring for Older African Americans' program aims to train healthcare professionals using storytelling videos about racism in end-of-life care, cultural guidelines, and bias management training to improve communication and care delivery.

How Is the Trial Designed?

Group I: Clinician Trainees- Cluster 4 Experimental Treatment 1 Intervention

Within each participating institution, clinician clusters are randomized to 1 of 4 start date training times for the African American Communities Speak (AACS) Education Intervention. Each arm has a pre-intervention (control) period and a post-intervention (exposure) period

Group II: Clinician Trainees- Cluster 3 Experimental Treatment 1 Intervention

Within each participating institution, clinician clusters are randomized to 1 of 4 start date training times for the African American Communities Speak (AACS) Education Intervention. Each arm has a pre-intervention (control) period and a post-intervention (exposure) period

Group III: Clinician Trainees- Cluster 2 Experimental Treatment 1 Intervention

Within each participating institution, clinician clusters are randomized to 1 of 4 start date training times for the African American Communities Speak (AACS) Education Intervention. Each arm has a pre-intervention (control) period and a post-intervention (exposure) period

Group IV: Clinician Trainees- Cluster 1 Experimental Treatment 1 Intervention

Within each participating institution, clinician clusters are randomized to 1 of 4 start date training times for the African American Communities Speak (AACS) Education Intervention. Each arm has a pre-intervention (control) period and a post-intervention (exposure) period.

Who Is Running the Clinical Trial?

University of Alabama at Birmingham

Lead Sponsor

Trials

1,677

Recruited

2,458,000+

Montefiore Medical Center

Collaborator

Trials

468

Recruited

599,000+

University of California, San Francisco

Collaborator

Trials

2,636

Recruited

19,080,000+

University of Massachusetts, Worcester

Collaborator

Trials

372

Recruited

998,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3935672/

A Systematic Review of Barriers and Facilitators to Minority ... African Americans' negative personal experiences with the health care system, such as racism, differential treatment, and feelings of mistrust, may create ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4626334/

Strategies to Build Trust and Recruit African American and ... This study used Community Partnered Participatory Research (CPPR) to address low participation of racial and ethnic minorities in medical research.

3. digitalcommons.csp.edu digitalcommons.csp.edu/cgi/viewcontent.cgi?article=1027&context=human-services_masters

The Role of Narratives and Shared Experiences of Systemic ... The study seeks to explore how narratives and shared lived experiences of systemic racism within the Black community influence the reluctance to.

4. apha.org apha.org/policy-and-advocacy/public-health-policy-briefs/policy-database/2023/01/18/address-systemic-racism-and-violence

Address Systemic Racism and Violence A Strategy to Address Systemic Racism and Violence as Public Health Priorities: Training and Supporting Community Health Workers to Advance ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S0002929721001336

Engagement and return of results preferences among a ... All groups raised the issue of mistrust. Individuals participated nonetheless to contribute their perspectives and benefit their community. Many group members ...

6. healthaffairs.org healthaffairs.org/doi/10.1377/hlthaff.2021.01394

Systemic And Structural Racism: Definitions, Examples, ... Finally, systemic racism can lead to poorer health among people of color at all economic levels by exposing them chronically to race-based unfair interpersonal ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10498908/

Racism as a determinant of health and health care Providing context. Race does not determine someone's health, but the experience of racism has a profound effect. · Racism as a determinant of health and health ...

8. news.stanford.edu news.stanford.edu/stories/2022/02/examining-systemic-racism-advancing-racial-equity

Examining systemic racism, advancing racial equity Teaching about racism. Stanford sociologist Matthew Snipp discusses ways to educate students about race and ethnic relations in America.

9. news.mcmaster.ca news.mcmaster.ca/analysis-failure-to-include-black-communities-in-health-policy-public-engagement-perpetuates-health-disparities/

Analysis: Failure to include Black communities in health policy ... It is time for us to accept that policy failure and lack of community engagement in policy decision-making go hand-in-hand. The fact that the communities ...

10. msm.edu msm.edu/Research/research_centersandinstitutes/PRC/preventionPrograms.php

Prevention Research Programs The theme of the PRC is: Risk Reduction and Early Detection in African American and Other Minority Community-Coalitions for Prevention Research. ... The Center's ...