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Race-conscious serious illness communication: An interpersonal tool to dismantle racism in practice and research

Published online by Cambridge University Press:  05 April 2023

William E. Rosa Open the ORCID record for William E. Rosa [Opens in a new window] ,
Crystal E. Brown  and
J. Randall Curtis
William E. Rosa*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Crystal E. Brown
Affiliation:
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, WA, USA
J. Randall Curtis
Affiliation:
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, WA, USA
*
Author for correspondence: William E. Rosa, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th fl, New York, NY 10022, USA. Email: rosaw@mskcc.org
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Abstract

Background

Racism significantly contributes to inequitable care quality and outcomes for people of color with serious illness, their families, and their communities. Clinicians use serious illness communication (SIC) to foster trust, elicit patients’ needs and values, and deliver goal-concordant services. Current SIC tools do not actively guide users to incorporate patients’ experiences with racism into care.

Objectives

1) To explicitly address racism during SIC in the context of the patient’s lived experience and 2) to provide race-conscious SIC recommendations for clinicians and researchers.

Methods

Applying the conceptual elements of Public Health Critical Race Praxis to SIC practice and research through reflection on inclusive SIC approaches and a composite case.

Results

Patients’ historical and ongoing narratives of racism must be intentionally welcomed in physically and psychologically safe environments by leveraging empathic communication opportunities, forging antiracist palliative care practices, removing interpersonal barriers to promote transparent patient–clinician relationships, and strengthening organizational commitments to strategically dismantle racism. Race-conscious SIC communication strategies, skills, and examples of talking points are provided.

Discussion

Race-conscious SIC practices may assist to acknowledge racial dynamics within the patient–clinician encounter. Furthermore, race-conscious SIC may help to mitigate implicit and explicit bias in clinical practices and the exclusionary research cultures that guide them.

Keywords

RacismHealth communicationSerious illness communicationPalliative carePublic Health Critical Race PraxisCritical race theory
Type
Review Article
Information
Palliative & Supportive Care , Volume 21 , Issue 3 , June 2023 , pp. 492 - 497
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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