Outcomes. 1. Gain understanding of relevance of cultural values to end-of-life care 2. Gain insight into community-based participatory research methods (partnering with the community) 3. Learn about ...appropriate training methods Importance. End of life (EoL) values in the US are historically rooted in the cultural and religious values of the White middle-class. Lack of understanding of cultural differences may significantly compromise EoL care for African Americans (AAs). Cultural competence among clinicians increases the likelihood of providing high-quality goal-concordant care. Objective(s). Assess the effectiveness of a training program that includes videos developed by the AA community in a community-based participatory research–guided study and a skills-based and reflective communication training program for 44 interprofessional palliative care providers, on their knowledge of AA cultural values and changes in practice. Method(s). The 3-hour training consists of 4 parts: overview of relevance of culture to EoL and description of the study in which the AA community members created the videos with their message to clinicians on providing culturally concordant care, viewing the videos, a skill-based and reflective communication program, and discussion with an AA chaplain on faith and religion in serious illness among AA Christians. Results. Knowledge of AA cultural values: 40/44 completed this survey. There was a statistically significant increase in knowledge of the following AA community values: how to share prognosis, God decides, central role of pastors in decision making, and belief in miracles. Change in practice: 30 responded to a self-report on implementation of community-made recommendations in practice 3 months after training. There was an increase in including family in discussions (80%), emphasizing hope (73%), and assuring patients that they were receiving best care (73%). Conclusion(s). This AA community-developed training resulted in significant increases in clinicians' knowledge of AA attitudes and beliefs and in incorporating AA community-recommended changes in their clinical practice. Impact. This has become an established training program at the University of Alabama at Birmingham Center for Palliative and Supportive Care from clinicians all over the US. Learning from AA communities is the first necessary step towards achieving health equity.
1. Recognize disparities in end-of-life care for African Americans
2. Understand the need for culturally concordant goals-of-care conversation guidelines
3. Understand how to partner with the African ...American community
Substantial evidence exists of nonequitable end-of-life care provided to African Americans (AAs), such as clinicians not abiding by the AA patient or family's desired goals of care (GoC), disregarding cultural values of hope and miracles, and labeling requested life-sustaining care aggressive. A higher proportion of AAs report receiving non–goal-concordant care. The development of a Culturally Sensitive GoC Conversation Guide that begins by building on the AA community's values and is created in partnership with the AA community remains unmapped.
Develop a culturally sensitive GoC Conversation Guide for clinicians caring for older AAs with serious illness, in full partnership with members of a Southern AA community; develop a clinician training program; and train clinicians in its use.
Community-based participatory research, in which community members are full partners in the process, guides all study phases. Phase 1: Develop a Community Advisory Group (CAG) and implement all their recommendations. Phase 2: Conduct focus groups with a) pastors and caregivers. Phase 3: Develop the guide based on themes from focus groups. Phase 4: Develop the training program. Phase 5: Train clinicians.
Phase 1 is complete. CAG (8 members) has held 15 meetings and advised the research team on all aspects of the study.
Phase 2: CAG recruited pastors for the pastor focus group and are now recruiting caregivers at local community centers. Focus groups (3 meetings) with 8 pastors have been held. Key themes included the need for clinicians to respect the humanity of the AA patient, provide time for the family to process and discuss, and include pastors in the conversation.
Community support has resulted in successful implementation of Phase 1 and beginning Phase 2. An NIH grant has been submitted for funding of Phases 3-5.
Partnering with AA communities in developing and implementing culturally relevant programs is the key element in providing equitable care.
Outcomes
1. Describe the process of developing pediatric palliative care (PPC) learning objectives for adult-track physician fellows
2. Discuss findings of the AAHPM Pediatric Curriculum Work Group ...national survey highlighting the need for more community-based PPC resources and improved PPC education and competency building for adult hospice and palliative medicine fellows
3. Recognize the key differences between pediatric and adult palliative care
The pediatric hospice and palliative medicine (pHPM) workforce is limited in its ability to care for an increasing population of medically fragile children, due to a lack of both pHPM training opportunities and pediatric-focused community resources. Given this relative shortage of pHPM resources, it is likely that adult HPM (aHPM) specialists will be called upon to provide PPC throughout their careers. Unfortunately, aHPM fellows often graduate having little, if any, pediatric exposure during their subspecialty training. Exposure to pediatric palliative care (PPC) during aHPM fellowship varies significantly, with no clear delineation of curricular content.
In 2019, AAHPM created the Pediatric Curriculum Work Group (PCWG) to further define the specific curricular aspects expected of all HPM fellow trainees related to working with children. Stemming from the previous work defining adult and pediatric HPM competencies, together with the recently completed Entrustable Professional Activities, Curricular Milestones, and Reporting Milestones, the AAHPM PCWG comprehensively drilled down on the specific knowledge, skills, and attitudes unique to PPC practice.
The PCWG created a set of fundamental PPC learning objectives (LOs) that are meant to help standardize and guide educators as they teach these essential concepts to aHPM fellows. The PCWG accomplished this task by completing a 2-phase project: survey current AAHPM physician members to map PPC curricula for aHPM fellows, assess perceived PPC curricular needs, and identify aHPM specialists who currently provide PPC; and, using a consensus process, apply survey data and build, refine, and publish 40 PPC LOs across 10 core domains of PPC practice.
This interactive session will review the PCWG survey data and process by which the PPC LOs were created and formalized. We will review the PCWG resource guide for fellowship programs and highlight suggested next steps for building feasible PCC curricula for aHPM fellows
What accounts for the development of the Arab states system from the explosive mix of Arab nationalism and sovereignty to their simultaneous existence? To understand this development, one must first ...examine how institutions can shape the very interests and roles of states in such a manner as to encourage the development of relatively stable expectations and shared norms; that is, regional order. This approach illuminates how inter-Arab interactions and state formation processes led to the consolidation of sovereignty and a meaning of Arab nationalism that is consistent with sovereignty. Consequently, this region highlights how sovereignty—and its lack thereof—is consequential for understanding interstate dynamics, and how different meanings of the nation have different implications for security.
The perceived orientation of objects, gravity, and the body are biased to the left. Whether this leftward bias is attributable to biases in sensing or processing vestibular, visual, and body sense ...cues has never been assessed directly. The orientation in which characters are most easily recognized--the perceived upright (PU)--can be well predicted from a weighted vector sum of these sensory cues. A simple form of this model assumes that the directions of the contributing inputs are coded accurately and as a consequence participants tilted left- or right-side-down relative to gravity should exhibit mirror symmetric patterns of responses. If a left/right asymmetry were present then varying these sensory cues could be used to assess in which sensory modality or modalities a PU bias may have arisen. Participants completed the Oriented Character Recognition Test (OCHART) while manipulating body posture and visual orientation cues relative to gravity. The response patterns showed systematic differences depending on which side they were tilted. An asymmetry of the PU was found to be best modeled by adding a leftward bias of 5.6° to the perceived orientation of the body relative to its actual orientation relative to the head. The asymmetry in the effect of body orientation is reminiscent of the body-defined left-leaning asymmetry in the perceived direction of light coming from above and reports that people tend to adopt a right-leaning posture.
PDF
