Black Health Identification Program (B-HIP)

The University of Alabama at Birmingham

Status: Completed

Conditions: Family Members; Multiple Chronic Conditions

Treatments: Behavioral: "My Health Priorities" Identification Program

Study type: Interventional

Funder types: Other

Identifiers

NCT05129709

Kornfeld Scholar Award (Other Grant/Funding Number)

IRB-300007623

Details and patient eligibility

About

Nearly 69% of African American (AA) Medicare beneficiaries have multiple chronic conditions (MCCs) such as cancer and cardiopulmonary diseases. Older age and MCCs are guideline-recommended indications for referral to early palliative care to assist with effective communication and value-solicitation surrounding treatment decision-making. Studies have shown that early palliative care participation achieves beneficial goals of care communication, quality of life (QOL), symptom burden, and mood in older adults with cancer and heart failure as well as among their family caregivers. However, older AAs with MCCs, especially those living in the Deep South, are less likely to have access to early palliative care, even though they generally experience higher symptom burden, healthcare use, and poorer communication around goals of care. This disparity in palliative care use may be, in part, to a lack of culturally-responsive care practices that effectively activate AAs with MCCs to identify their own values and priorities for end-of-life care. While efficacious communication models exist, few have been tested in culturally-diverse samples. Guided by the theory of Social Cognitive Theory and Health Behavior Model, this study's purpose is to conduct a formative evaluation of a Self-directed "My Health Priorities" Identification Program to determine cultural acceptability and feasibility of use in among AAs with MCCs in a primary care setting. The 2-phase study specific aims are to:

Aim 1. (Phase 1) Conduct a single-arm formative evaluation trial of Self-directed "My Health Priorities" Identification Program to determine acceptability and feasibility with a sample of 20 AA patients with MCCs and FCGs and adapt for future efficacy testing.

Aim 2. (Phase 2) To examine the ability of the dyads to complete pre- and post-test measures of perception of care, treatment burden, shared decision-making, and communication exchange.

The findings from the research will directly inform a small-scale pilot grant that will assess acceptability, feasibility, and potential efficacy of a values solicitation and operationalization intervention for AAs with MCCs and caregivers.

Enrollment: 30 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria for Patients

• African American (AA)
• ≥ 65 years
• has at least two of the following chronic conditions: cancer, heart disease, kidney disease, liver disease
• English-speaking
• cognitively able to participate in decision-making discussions
• reliable internet and telephone access
• FCG willing to participate in study

Inclusion Criteria for FCG

• AA

  • 18 years

• identified by patient as his/her primary FCG

• English-speaking; and 5) reliable internet and telephone access.

Exclusion Criteria for Patients and FCG

• Axis I psychiatric disorder (schizophrenia, bipolar disorder), dementia
• active substance use disorder
• living in a nursing home or assisted living facility residence.

Trial design

Primary purpose: Supportive Care

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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30 participants in 1 patient group

"My Health Priorities" Identification Program

Experimental group

Description:

The intervention, the "My Health Priorities" Identification Program consists of four self-directed, web-based modules intended to guide patients with MCCs in identifying their own health priorities. These priorities can then be used to guide discussions with family caregivers and clinicians regarding specific goals and preferences that they wish to guide future treatment decisions. Most models of palliative care have been developed based on white middle-class populations and may not apply to African Americans (AA) who have a very different cultural value set.

Treatment:

Behavioral: "My Health Priorities" Identification Program