Training Program to Improve End-of-Life Care for Older African Americans by Addressing Racism and Cultural Needs

What this Trial Is About

African Americans often face disparities in receiving quality end-of-life EoL care, including less frequent and less effective communication about care goals. This research project focuses on improving culturally aligned EoL care for older African Americans by addressing systemic racism, cultural values, and implicit bias in healthcare settings. The study aims to adapt and test a training program that empowers clinicians to better understand and meet the EoL needs of African American patients in both Northern and Southern urban communities. The study uses a behavioral intervention called AA Communities Speak to Healthcare Professionals, which includes community-developed storytelling videos highlighting experiences of racism, guidelines for culturally respectful care, and training on recognizing and managing implicit bias. Clinician groups are randomized to begin this training at one of four different start dates, with each group experiencing a period without the intervention followed by the training exposure. This stepped wedge design allows all clinicians to receive the training while controlling for external factors. Participants include clinicians and African American patients aged 60 or older with serious illnesses such as cancer, cardiac or pulmonary disease, neurodegenerative conditions, and others, as well as bereaved family members and pastors. Data collection includes patient and family surveys before and after the intervention to measure perceptions of therapeutic alliance and goal-concordant care. Researchers will also assess clinicians cultural knowledge, awareness of bias, and confidence in applying these principles. The study will continue through 2028, with outcomes monitored up to three months before and after training.

African Americans (AA) Communities Speak