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召集西班牙裔/拉丁裔照护顾问参与痴呆症姑息治疗的包容性研究。

Convening Hispanic/Latino Caregiving Advisors for Inclusive Research in Dementia Palliative Care.

作者信息

Rivers Caroline, Ramirez Gomez Liliana, Hanson Laura C, Ritchie Christine S, Fischer Stacy M, Mino Ilian, Chavez Granados Heily, Lynch Molly, Lum Hillary D

机构信息

Division of Geriatric Medicine & Palliative Care and Hospice Program, Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.

Memory Disorders Division, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.

出版信息

J Palliat Med. 2025 Apr;28(4):484-491. doi: 10.1089/jpm.2024.0335. Epub 2025 Jan 28.

Abstract

Dementia clinical trials often fail to include diverse and historically minoritized groups. We sought to adapt the Alzheimer's Disease and Related Dementias-Palliative Care (ADRD-PC) clinical trial to improve enrollment and address the cultural needs of people with late-stage ADRD who identify as Hispanic or Latino and their family caregivers. Bilingual, bicultural research team members adapted study materials and processes using the Cultural Adaptation Process Model. Investigators and research staff held three meetings with eight Hispanic/Latino advisors-seven dementia caregivers and one health care professional. The first two meetings informed linguistic and cultural adaptation of study materials and processes. After piloting the adapted materials with Hispanic/Latino patient-caregiver dyads in the ADRD-PC study, the third meeting focused on refining protocols for recruitment. Key reflections from advisor meetings guided cultural adaptation: lived experiences on dementia caregiving; patient, caregiver, and clinician interactions in the health care system; and limited knowledge and misconceptions of palliative care. Adaptations to the ADRD-PC study materials included specific consideration of preferred language, word choices (i.e., "palliative care" and "caregiver"), and recruitment considerations related to potential barriers to palliative care or research in general. Cultural adaptation of the ADRD-PC dementia palliative care clinical trial protocol depended on participatory methods and collaboration between Hispanic/Latino caregiver advisors and researchers, including bilingual, bicultural team members. Comparable methods may inform future culturally inclusive approaches to clinical research and thus improve representation of minoritized groups in dementia care research.

摘要

痴呆症临床试验往往未能纳入多样化和历史上处于少数群体地位的人群。我们试图对阿尔茨海默病及相关痴呆症-姑息治疗(ADRD-PC)临床试验进行调整,以提高入组率,并满足自我认定为西班牙裔或拉丁裔的晚期ADRD患者及其家庭护理人员的文化需求。双语、双文化的研究团队成员采用文化适应过程模型对研究材料和流程进行了调整。研究人员和研究工作人员与八位西班牙裔/拉丁裔顾问举行了三次会议,其中包括七位痴呆症护理人员和一位医疗保健专业人员。前两次会议为研究材料和流程的语言及文化调整提供了信息。在ADRD-PC研究中对西班牙裔/拉丁裔患者-护理人员二元组试用了调整后的材料后,第三次会议重点讨论了完善招募方案。顾问会议的关键反思为文化调整提供了指导:痴呆症护理的实际经历;医疗保健系统中患者、护理人员和临床医生的互动;以及对姑息治疗的有限了解和误解。对ADRD-PC研究材料的调整包括对首选语言、词汇选择(即“姑息治疗”和“护理人员”)的具体考虑,以及与姑息治疗或一般研究的潜在障碍相关的招募考虑因素。ADRD-PC痴呆症姑息治疗临床试验方案的文化调整依赖于参与式方法以及西班牙裔/拉丁裔护理人员顾问与研究人员之间的合作,包括双语、双文化团队成员。类似的方法可能为未来具有文化包容性的临床研究方法提供信息,从而提高少数群体在痴呆症护理研究中的代表性。

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