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This chapter first summarizes eight threats to racial equity in health and healthcare identified in previous chapters. It then presents potential solutions to reduce their impact on Black Americans’ health. Two solutions involve lessening the impact of racial disparities in socioeconomic status on access to healthcare. The first involves broad-based efforts to improve the quality of education available to Black students, which should increase their future economic potential and thus ultimately improve their health. The second one is to establish comprehensive, single-payer insurance programs, making healthcare more available to everyone. Other proposed solutions address health threats caused by specific kinds of anti-Black racism. These solutions include programs to systematically reduce unfair and dangerous law enforcement practices and targeted investments in intentionally segregated communities to improve residents’ quality of life. A solution to the threat of inequitable healthcare is changing healthcare facilities’ focus from treating to preventing illnesses and dramatically increasing the number Black healthcare providers. Finally, a solution to the undue influence of patients’ race in healthcare outcomes is to develop interventions that reduce the impact of racial bias on healthcare professionals’ actions and equip Black Americans with the information and strategies that would make healthcare more accessible and supportive of them.
Early integration of palliative and cancer care improves the quality of life and is facilitated by discussions about the end of life after cessation of active cancer treatment between patients with advanced cancer and their physicians. However, both patients and physicians find end-of-life discussions challenging. The aim of this study was to assess the need for a question prompt list (QPL) that encourages end-of-life discussions between patients with advanced cancer and their physicians.
Focus group interviews (FGIs) were conducted with 18 participants comprising 5 pancreatic cancer patients, 3 family caregivers, 4 bereaved family members, and 6 physicians. Three themes were discussed: question items that should be included in the QPL that encourages end-of-life discussions with patients, family caregivers, and physicians after cessation of active cancer treatment; when the QPL should be provided; and who should provide the QPL. Each interview was audio-recorded, and content analysis was performed.
The following 9 categories, with 57 question items, emerged from the FGIs: (1) preparing for the end of life, (2) treatment decision-making, (3) current and future quality of life, (4) current and future symptom management, (5) information on the transition to palliative care services, (6) coping with cancer, (7) caregivers’ role, (8) psychological care, and (9) continuity of cancer care. Participants felt that the physician in charge of the patient's care and other medical staff should provide the QPL early during active cancer treatment.
Significance of results
Data were collected to develop a QPL that encourages end-of-life discussions between patients with advanced cancer and their physicians.
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