Perspectives About Racism and Patient-Clinician Communication Among Black Adults With Serious Illness

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Abstract
Racial inequities during serious illness and end of life (EOL) are well documented.1 In the last 6 months of life, Black patients were more likely to be hospitalized and admitted to the intensive care unit, receive mechanical ventilation and cardiopulmonary resuscitation (CPR), and die in the hospital, studies have found.2,3 This was associated with disproportionately high health care costs, a high symptom burden, and poor quality of life at EOL among Black patients.4 Spirituality and religion, health literacy, and mistrust have been used to explain why this higher-intensity care exists.2,4,5 For example, religious beliefs are cited as a reason Black patients may not desire prognostic information despite evidence suggesting otherwise.6,7 Additionally, low engagement in advance care planning (ACP) and hospice enrollment is often attributed to low levels of health literacy and related knowledge deficits.7,8 Traditional approaches to develop interventions addressing health disparities often ask Black patients to conform to White normativity and discount lived experiences and perspectives that are often marginalized by health care institutions. However, traditional, deficit-based approaches focused on changing patient personal attributes burden patients and their caregivers to correct health inequities rather than improving the trustworthiness of health care workers (HCWs) and institutions.

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