Not Just Equal: Developing Strategies for Equity in Serious Illness Communication Through Case Studies, Evidence, and Best Practice (FR259)

• Published in: Journal of pain and symptom management 2022-05, Vol.63 (5), p.823-823
• Main Authors: Walter, Jennifer, Needle, Jennifer, Desanto-Madeya, Susan, Izumi, Seiko, Frydman, Julia
• Format: Article
• Language: English
• Subjects: African Americans; Best practice; Bias; Cancer; Communication; Communication strategies; Competence; Cultural values; Discrimination; Equity; Group decision making; Health disparities; Illnesses; Immigrants; Interdisciplinary aspects; Language proficiency; Marginality; Naming; Palliative care; Patients; Psychological trauma; Racism; Specialists; Teams; Underserved populations; White supremacy
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.02.282

Outcomes 1. Describe the components of equity with respect to serious illness communication 2. Articulate the evidence of disparities in serious illness communication 3. Discuss strategies for ensuring equity in serious illness communication As palliative care grapples with how White supremacy has affected all aspects of patient care, we propose to reimagine what it means to achieve equity in communication about goals of care. We will start with a discussion of equity and how it can be applied to practices of serious illness communication, integrating the concepts of individual biases, structural biases, and structural determinants of health. Cases will be used to emphasize how forces can be overlapping and additive in an individual patient and family's experience. Then, we will review the body of evidence for disparities in communication and discuss further investigations to understand the implications for patients and families. With published examples of African Americans describing less satisfaction with communication and a lower quality of communication, we will examine the meaning of equal versus equitable communication strategies to push beyond applying same/equal communication strategies for all and strive instead to explore what would be different but equitable approaches to address some groups’ unique needs based on historical distrust, marginalization, trauma, or limited language proficiency. Examples from our presenters’ pilot data will be discussed about greater discordance in life-sustaining care preferences between adolescents with cancer and their parents for Black teens compared to their White peers as well as how patients from underserved populations respond to standardized approaches to eliciting goals of care using the Serious Illness Conversation Guide. Finally, our expert interprofessional team will highlight strategies to achieve equity in communication at the institutional level and as palliative care specialists. Examples include identifying community champions for underrepresented minority or immigrant groups to better understand cultural beliefs, communication practices, and language used by palliative care. Individual communication strategies include naming histories of discrimination, using trauma-informed care approaches, and recognizing that some standard shared decision-making approaches are alienating for some groups.