# African American (AA) Communities Speak: Partnering with AAs in the North and South to Train Palliative Care Clinicians to Address Interpersonal and Systemic Racism and Provide Culturally Aligned Care

> **NIH NIH R01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2024 · $659,416

## Abstract

PROJECT ABSTRACT
African Americans (AA) are less likely to receive quality end-of-life (EoL) care. For example, goals of care
conversations, which are critical discussions between clinicians, patients and families near the end of life, are
less likely to occur for AAs than for Whites, and preferences are less likely to be followed when they do occur.
Instead, families are more likely to be labelled as “difficult” if their decisions are incongruent with clinicians’
recommendations. EoL decisions for many AA persons are rooted in both culture and a lifetime of experiences
of structural racism. Efforts to address disparities need to address multiple factors such as patient-level cultural
identity and EoL care values, interpersonal- and community-level norms for EoL communication and treatment,
and healthcare institutional-contexts for delivering EoL care in a setting affected by institutional racism. Our
research group began to address this need with ‘African American Community Speaks’, a proof-of-concept
prototype of a community-developed training program for clinicians caring for AA older adults with serious illness.
The program originally focused on rural Southern older AAs and is not broadly generalizable across the US due
to geographic differences in culture, attitudes, and communication preferences among AA persons in the US.
Thus, we propose to adapt our prototype program to urban-dwelling Southern and Northern older AA adults
using our established platform of Community-Based Participatory Research (CBPR) in two geographically
diverse regions: Birmingham, Alabama and the Bronx, New York. To create the new training program called
‘Caring for Older African Americans’, our team of experts in CBPR, medical sociology, and clinical trials will
work with local Community Advisory Boards to: 1. Conduct a comparative ethnographic study of urban-
dwelling AAs in the North and South to describe AA community values and preferences related to EoL care; 2.
Adapt of our prior community-developed training program by integrating community-developed storytelling
videos for empathizing with experiences of racism in EoL care, guidelines for culturally concordant EoL care
deliver, and adapting an existing implicit bias management program to goals of care communication; and 3.
Conduct a cluster randomized trial in which we will randomize training times to 1 of 4 start dates using a
stepped wedge design to accommodate training of all clinicians and to mitigate the effect of secular trends.
Patients’ personal experience of racism will be measured using the discrimination subscale of the Group Based
Mistrust Scale. The primary outcome will be patient/family’s perception of therapeutic alliance using The Human
Connection Scale. Secondary outcomes will be family-reported goal-concordant care, and clinicians’ knowledge
of cultural values, awareness of implicit bias, and confidence to change practice. This innovative effort will be
the first training program that: 1. addr...

## Key facts

- **NIH application ID:** 10911294
- **Project number:** 5R01AG078255-02
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** RONIT ELK
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $659,416
- **Award type:** 5
- **Project period:** 2023-09-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10911294

## Citation

> US National Institutes of Health, RePORTER application 10911294, African American (AA) Communities Speak: Partnering with AAs in the North and South to Train Palliative Care Clinicians to Address Interpersonal and Systemic Racism and Provide Culturally Aligned Care (5R01AG078255-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10911294. Licensed CC0.

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