主題演講：土著文化安全與我有什么關系？.pdf

1、What is Indigenous Cultural Safety andWhat does it have to do with ME?Clinical Trials Ontario Conference 2024Janet Smylie MD MPH FCFP FCAHS FRSCDirector,Well Living House Action Research Centre and Staff Physician,St.Michaels Hospital Professor,Dalla Lana School of Public Health and DFCM,Faculty of

2、Medicine,University of TorontoTier 1 Canada Research Chair in Advancing Generative Health Services for Indigenous PopulationsTodays Presentation Indigenous cultural safety why it is relevant,what it is,what it is not;Reflecting on“Gold Standards”the need for humility,accountability,and epistemic sel

3、f-location approaching diversity of scientific methodologies with humility,respect,practicality,and shared long-term goals(ie.the desire to optimize human and global benefits of our work)Tailoring RCT methods to address Indigenous health issues(as identified and prioritized by Indigenous peoples)an

4、example Why Should I Be Concerned about Indigenous Cultural Safety?Persistent Indigenous/non-Indigenous Health Inequities in Canadapeer reviewed studies have revealed IMR rates that are 190%higher for First Nations compared to non-First Nations3 and 360%higher for Inuit inhabited areas compared to n

5、on-Inuit inhabited areas4 Smylie,Lancet:2013Health and social services are commonly of limited social value for First PeoplesTruth and Reconciliation Commission Call to Action:HealthMake the links between current Indigenous health disparities and Canadian governmental policiesEstablish measureable g

6、oals and close the gap in health outcomesRecognize and address distinct health needs of Inuit,Mtis and off-reserve Aboriginal peopleFund Aboriginal healing centres to address the physical,mental,emotional and spiritual harms caused by residential schoolsRecognize and use Aboriginal healing practices

7、Increase and retain Aboriginal health professionals;ensure all health professionals have cultural competency trainingCoursework and training in all medical and nursing schoolsWhat is Indigenous Cultural Safety?Cultural SafetyAdvancing relationships across difference through the skill of self-reflect

8、ion.Underpinned by an understanding of power differentialsTakes us beyond:Cultural awareness,the acknowledgement of difference;Cultural sensitivity,the recognition of the importance of respecting difference,and Cultural competence,which focuses on the skills,knowledge,and attitudes of practitioners.

9、www.sanyas.caWhat Does History and Epistemology Have to Do With This?“The problem with universities is that they teach us that we know better”Questions Do you know the history of and philosophical roots underlying RCTs?What is the epistemological and ontological framing of RCTs?What are the linked u

10、nderlying knowledge assumptions?What types of questions do RCTs work best to answer?What are some of the limitations of RCTs?Can RCT methods be tailored to address Indigenous community priorities?A randomized control trial at St.Michaels Hospital,St.Josephs Hospital,North York General Hospital,and C

11、redit Valley Hospital Involved 58 physicians,residents,and nurse practitioners from Family Medicine and the Emergency Department Compares the effectiveness of intensive,brief,and control interventions on Indigenous race bias outcomesStudy Goals:1.Establish an evidence base for effective Indigenous c

12、ultural safety education for healthcare professionals2.For Indigenous people to be offered high-quality,culturally safe careFunded by a generous donations made to St.Michaels Hospital Foundation by Donna and Gary Slaight,and John LedererReconciling Relationship Study:Reconciling Relationships Study

13、TeamCore TeamDr.Janet Smylie,Principal InvestigatorDr.Billie-Jo Hardy,Co-InvestigatorSam Filipenko,Research CoordinatorCultural Safety Implementation Advisory GroupDr.Cheryl Ward,Jane Collins,Diane Smylie,Dr.Linda Weber,Dr.Braden ONeill,Dr.Melissa Graham,Dr.Ali Damji,Dr.Aisha Lofters,Dr.Nav Persaud,

14、Dr.Katreena Scott,Dr.Marcia Anderson,Dr.Patricia Devine,Dr.William Cox,Dr.Kristina KlopferSanyas Registrar(Leresha Lickers),Curriculum Development,and Facilitation TeamsUnity Health Toronto First Nations,Inuit,and Mtis Community Advisory PanelIndigenous Standardized Patient Acting TeamStudy DesignSt

15、udy Design3-armed RCTPre-InterventionInterventionPost-InterventionImplicit bias measures Explicit bias measures123Big Canoe:Big Canoe:10-hour facilitated online curriculumLittle Canoe:Little Canoe:1-hour anti-bias training sessionControl:Control:10-hours of non-Indigenous health educationImplicit bi

16、as measures Explicit bias measuresUISP visit(double blinded)DebriefRandom assignment of participants into the study arms8-10 weeksStudy Results:Question 14 Patient Experience Odds Ratio(95%Confidence Interval)CrudeAge and Gender AdjustedAge,Gender and Previous Indigenous Experience AdjustedAge,Gende

17、r and Positive Experience Adjusted Big Canoe3.929 (0.925,19.323)5.723 (1.156,36.779)6.875 (1.310,49.396)7.263 (1.349,53.493)Little Canoe3.300 (0.657,18.729)6.616 (1.074,54.663)7.784 (1.191,73.311)7.113 (1.129,60.303)Would you recommend this health care provider to family or friends?(not recommend;re

18、commend with reservations;recommend;highly recommend)Actions Take an evidence based Indigenous cultural safety training Reflect on and adapt strategies to interrupt your social and scientific biases Identify the paradigm and assumptions underlying your own scientific discipline reflect on the streng

19、ths and limitations Work to advance equitable distribution of resources for Indigenous scientists and Indigenous science Todays Presentation Indigenous cultural safety why it is relevant,what it is,what it is not;Reflecting on“Gold Standards”the need for humility,accountability,and epistemic self-lo

20、cation approaching diversity of scientific methodologies with humility,respect,practicality,and shared long-term goals(ie.the desire to optimize human and global benefits of our work)Tailoring RCT methods to address Indigenous health issues(as identified and prioritized by Indigenous peoples)an example Questions?