Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training
Abstract Background Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly corr...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-023-03193-y |
| _version_ | 1827382132767457280 |
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| author | Janet Smylie Michael A. Rotondi Sam Filipenko William T. L. Cox Diane Smylie Cheryl Ward Kristina Klopfer Aisha K. Lofters Braden O’Neill Melissa Graham Linda Weber Ali N. Damji Patricia G. Devine Jane Collins Billie-Jo Hardy |
| author_facet | Janet Smylie Michael A. Rotondi Sam Filipenko William T. L. Cox Diane Smylie Cheryl Ward Kristina Klopfer Aisha K. Lofters Braden O’Neill Melissa Graham Linda Weber Ali N. Damji Patricia G. Devine Jane Collins Billie-Jo Hardy |
| author_sort | Janet Smylie |
| collection | DOAJ |
| description | Abstract Background Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. Method Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. Results Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. Conclusions Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. Trial registration Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023. |
| first_indexed | 2024-03-08T14:15:08Z |
| format | Article |
| id | doaj.art-5dbb6d7d3f2746679f81b5c305e5b7a4 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-03-08T14:15:08Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-5dbb6d7d3f2746679f81b5c305e5b7a42024-01-14T12:26:06ZengBMCBMC Medicine1741-70152024-01-0122111210.1186/s12916-023-03193-yRandomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety trainingJanet Smylie0Michael A. Rotondi1Sam Filipenko2William T. L. Cox3Diane Smylie4Cheryl Ward5Kristina Klopfer6Aisha K. Lofters7Braden O’Neill8Melissa Graham9Linda Weber10Ali N. Damji11Patricia G. Devine12Jane CollinsBillie-Jo Hardy13Well Living House, Unity Health Toronto - St. Michael’s HospitalSchool of Kinesiology and Health Science, York UniversityWell Living House, Unity Health Toronto - St. Michael’s HospitalInequity Agents of ChangeOntario Federation of Indigenous Friendship CentresAnti-Indigenous Racism ConsultantWell Living House, Unity Health Toronto - St. Michael’s HospitalWomens College Hospital, Women’s College HospitalMAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health TorontoDepartment of Family and Community Medicine, University of TorontoSt. Josephs Heath Centre Family Medicine/Urban Family Health TeamCredit Valley Family Health TeamDepartment of Psychology, University of Wisconsin - UW-MadisonDalla Lana School of Public Health, University of TorontoAbstract Background Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. Method Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. Results Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. Conclusions Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. Trial registration Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.https://doi.org/10.1186/s12916-023-03193-yIndigenous cultural safetyMedical educationRacism in health careRace biasHealth care disparitiesClinical trial |
| spellingShingle | Janet Smylie Michael A. Rotondi Sam Filipenko William T. L. Cox Diane Smylie Cheryl Ward Kristina Klopfer Aisha K. Lofters Braden O’Neill Melissa Graham Linda Weber Ali N. Damji Patricia G. Devine Jane Collins Billie-Jo Hardy Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training BMC Medicine Indigenous cultural safety Medical education Racism in health care Race bias Health care disparities Clinical trial |
| title | Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training |
| title_full | Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training |
| title_fullStr | Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training |
| title_full_unstemmed | Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training |
| title_short | Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training |
| title_sort | randomized controlled trial demonstrates novel tools to assess patient outcomes of indigenous cultural safety training |
| topic | Indigenous cultural safety Medical education Racism in health care Race bias Health care disparities Clinical trial |
| url | https://doi.org/10.1186/s12916-023-03193-y |
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