Racial Differences in Shared Decision-Making About Critical Illness

JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(4), P. 424 - 424

Published: Feb. 26, 2024

Importance Shared decision-making is the preferred method for evaluating complex tradeoffs in care of patients with critical illness. However, it remains unknown whether clinicians engage diverse and caregivers equitably shared decision-making. Objective To compare clinicians' approaches to recorded conversations Black White Design, Setting, Participants This thematic analysis consisted unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial decision aid about prolonged mechanical ventilation at 13 intensive units US. included or who underwent ventilation. The codebook components known mechanisms racial disparities communication. Analysts were blinded caregiver race coding. Patterns within across groups evaluated identify themes. Data was conducted between August 2021 April 2023. Main Outcomes Measures main outcomes themes describing clinician behaviors varying by self-reported caregivers. Results overall sample comprised 20 19 total 39 clinicians. duration similar both (mean [SD], 23.9 [13.7] minutes vs 22.1 [11.2] minutes, respectively). Both generally middle-aged [SD] age, 47.6 [9.9] years 51.9 [8.8] years, respectively), female (15 [75.0%] 14 [73.7%], possessed high level self-assessed health literacy, which scored from 3 15 lower scores indicating increasing literacy 5.8 [2.3] 5.3 [2.0], Clinicians conducting young 38.8 [6.6] 37.9 [8.2] male (13 [72.2%] 12 [70.6%], (14 [77.8%] 17 [100%], Four variations identified: (1) providing limited emotional support caregivers, (2) failing acknowledge trust gratitude expressed (3) sharing medical information (4) challenging caregivers' preferences restorative care. These encompass relational informational aspects Conclusions Relevance results this showed that missed opportunities emotions value knowledge compared findings may inform future clinician-level interventions aimed promoting equitable

Language: Английский

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Discriminatory Healthcare Experiences and Medical Mistrust in Patients With Serious Illness

Journal of Pain and Symptom Management, Journal Year: 2024, Volume and Issue: 67(4), P. 317 - 326.e3

Published: Jan. 11, 2024

Language: Английский

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Uncovering Structurally Differential Care: Pediatric Oncology Nurses’ Perspectives Caring for African American Families

Journal of Pain and Symptom Management, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review

Spine Deformity, Journal Year: 2025, Volume and Issue: unknown

Published: March 6, 2025

Language: Английский

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Themes in the Management of Pediatric Brain Death Contestation: Exploratory Qualitative Work From Multidisciplinary Health Professionals in the United States

Pediatric Critical Care Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 23, 2025

Objectives: To explore health professionals’ experiences of contested pediatric brain death/death by neurologic criteria (BD/DNC) cases, including factors contributing to conflict, resource needs and utilization, perceived utility supports available, case resolution aftermath. Design Methods: Inductive thematic analysis semistructured interviews with members the Society Critical Care Medicine (SCCM) Contestation Pediatric Brain Death Task Force. Setting: Ten institutions across seven U.S. states District Columbia. Participants: Nineteen Force were interviewed in 2023, intensivists, neurologists, nurses, respiratory therapists, attorneys, palliative care clinicians, social workers, ethicists, hospital leadership. recruited primarily because their experience BD/DNC, although some expertise other relevant topics, such as communication, information acquisition equity. Interventions: None. Measurements Main Results: We identified five themes managing BD/DNC contestation: 1) personnel consider involving, subspecialty consultation, work, leadership administration, ethics teams, legal counsel, security; 2) timelines maintain, when deciding most appropriate family accommodations; 3) support for families patients, strategies enhance identifying mitigating mistrust, connecting both within outside hospital; 4) staff, disseminating throughout team, staff one another, establishing written documentation policies; 5) complementary that may augment approaches contestation, policies addressing requests potentially inappropriate treatment. Conclusions: Family contestation challenges all parties involved. The from our qualitative experienced professionals do not constitute SCCM clinical practice guidance, but they will be used inform development through further scholarship community consultation.

Language: Английский

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Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study

Journal of General Internal Medicine, Journal Year: 2024, Volume and Issue: 39(14), P. 2747 - 2754

Published: Aug. 26, 2024

Abstract Background Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at end life that negatively impact this group. However, there are few studies describe patient perspectives around racism and discriminatory experiences on within context serious illness. Objective To better characterize discrimination with illness its association medical mistrust. Participants Seventy-two participants hospitalized an academic county hospital. Approach This is a convergent mixed methods study using data from participant-completed surveys existing semi-structured interviews eliciting participants’ their racism, communication, decision-making. Main Measures The experience Group-Based Mistrust (GBMM) scale scores, validated measure Key Results Of 72 participants, 35% participated in interviews. were mostly men who had significant socioeconomic disadvantage, including low levels wealth, income, educational attainment. There reported high race-based overall GBMM score (mean [SD], 36.6 [9.9]), as well scores suspicion (14.2 [5.0]), group disparities healthcare (9.9 [2.8]), lack support (9.1 [2.7]) subscales. Three qualitative themes aligned expressed skepticism workers (HCWs) modern medicine, recounted personal setting, frustrated poor communication HCWs. Conclusions found Suspicion HCWs, by race, HCWs overarching influenced Critical, race-conscious approaches needed create strategies frameworks improve trustworthiness institutions workers. Graphical abstract

Language: Английский

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A sense of injustice in care networks: An intersectional exploration of the collaboration between professionals and carers with a migration background.

Social Science & Medicine, Journal Year: 2024, Volume and Issue: 356, P. 117169 - 117169

Published: July 31, 2024

This study tries to understand the power of knowledge within collaborative care networks provide insights for designing successful collaboration by combining intersectionality and epistemic (in)justice. Becoming an informal carer someone with acquired brain injury (ABI) causes a dramatic disruption daily life. Collaboration between professionals carers migration background may result in unjust unfair situations networks. Carer experiences are shaped aspects diversity which subject structures processes social (in)justice In this study, was used both generate complex in-depth into different active layers focus on within-group differences. Intersectionality combined theoretical concept unravel underlying dynamics contributing understanding that often not seen as 'knowers reality.' qualitative conducted Netherlands 2019 2022 incorporated three group conversations (N = 32), semi-structured interviews 21), dialogue sessions 7) caring ABI. A critical friend community practice, carers, professionals, recipients 8), contributed analysis. Three interrelated themes were identified constituting experience: (a) I need keep going, focusing carers' personal how related positioning; (b) struggle together, showing expectations family members towards added burden; (c) trust is balancing act, centering support from experiences, trusting professionals' proved challenging influenced contextual factors at organizational policy levels. Overall, diversity-responsive policies organizations apparent. Carers feel heard so they can meaningfully tailor meet recipients' needs.

Language: Английский

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“He was not listening to hear me”: Parent experiences with communication, inclusion, and marginalization in the pediatric emergency department

Academic Emergency Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 6, 2025

Abstract Objective Inequities in pediatric emergency department (ED) care may be influenced by disparities clinician communication. We sought to examine, from the perspective of parents marginalized racial and ethnic backgrounds, how clinician–parent communication is characterized during ED visits. Methods conducted analyzed in‐depth semistructured individual interviews with patients backgrounds. applied a constant comparative method approach conduct thematic analysis informed grounded theory. To ensure rigor, we collected data concurrently. used patient‐centered (PCC) framework 10 principles Public Health Critical Race Praxis as sensitizing constructs analysis. Two coders followed several analytical steps: (1) open coding for concept discovery, (2) grouping concepts into themes, (3) axial identify properties, (4) identification exemplar excerpts rich description. Thematic saturation was based on repetition, recurrence, forcefulness. Results Nineteen participated. Parents described three communicative behaviors that facilitated their sense inclusion or marginalization: information exchange, empathic communication, partnership‐building. also stressed importance own proactive facilitating inclusion. Few participants experiencing racism child's visit, yet many did prior health encounters, which they connected current experience. In particular, use motivated past experiences medical encounters. Conclusions These narratives demonstrate ways experienced racism, both present, inform receive respond gaps PCC. Communication focused interventions adapt race‐conscious have role promoting equity.

Language: Английский

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COVID-19 as a Mirror: Reflecting the Pandemic of Racism and the Historical Roots of Health Inequities

International Journal of Environmental Research and Public Health, Journal Year: 2025, Volume and Issue: 22(2), P. 273 - 273

Published: Feb. 13, 2025

Historically, the attribution of biology to race has shaped societies and manifested in innumerable disparities irreparable harm, especially communities color. From earliest days United States present day, dehumanization "othering" African Americans have caused deep racial inequities that been perpetuated embedded American culture. The early months COVID-19 pandemic underscored inequalities US, health outcomes for Structural racism played a critical role exacerbating disparities, with Black, Hispanic, Latinx, Indigenous populations experiencing higher rates severe disease mortality. interconnectedness social determinants health, concomitant chronic illnesses like diabetes hypertension, increases vulnerability COVID-19. Health are compounded by implicit biases medical field, lack diversity among healthcare providers, historical mistrust marginalized groups. Underrepresentation biomedical sciences, academia hinders efforts address effectively. This essay seeks raise awareness how concepts resulted hierarchies perpetuate systems oppression impede toward equity. Specifically, this covers time periods history, including slavery, Jim Crow Era, Civil Rights Movement, pandemic, discusses addressing achievement equity require targeted increase fields, improve cultural competence, foster trust between professionals

Language: Английский

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A multi-perspective study assessing Black and African American participation barriers in prostate cancer clinical trials

Future Oncology, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 7

Published: Feb. 24, 2025

Aims This study aimed to partner with patients, advocates, and physicians better understand the barriers that exist for Black African Americans enroll in prostate cancer (PCa) clinical trials.

Language: Английский

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