The aim of this study was to examine interdisciplinary clinicians’ perceptions of priorities in serious illness communication and shared decision-making with racially and culturally minoritized persons at end of life. Clinicians (N= 152) read a detailed case study about a patient self-identifying as Black and American Indian who describes mistrust of the healthcare system. Participants then responded to three open-ended questions about communication strategies and approaches they would employ in providing care. We conducted a thematic analysis of participants’ responses to questions using an iterative, inductive approach. Interdisciplinary clinicians from nursing (48%), social work (36%), and chaplaincy (16%), responded to the study survey. A total of four themes emerged: (1) person-centered, authentic, and culturally-sensitive care; (2) pain control; (3) approaches to build trust and connection; and (4) understanding communication challenges related to racial differences. Significant efforts have been made to train clinicians in culturally inclusive communication, yet we know little about how clinicians approach “real world” scenarios during which patients from structurally minoritized groups describe care concerns. We outline implications for identifying unconscious bias, informing educational interventions to support culturally inclusive communication, and improving the quality of end-of-life care for patients with cancer from minoritized groups.
本研究旨在探讨跨学科临床医生在与种族及文化少数群体临终患者进行重病沟通和共享决策时所感知的优先事项。152名临床医生阅读了一份详细案例研究，该案例描述了一位自我认同为非裔美国原住民的病人，其对医疗系统表达了不信任。参与者随后回答了三个开放式问题，涉及他们在提供护理时会采用的沟通策略与方法。我们采用迭代归纳法对参与者的回答进行了主题分析。参与调查的跨学科临床医生来自护理（48%）、社会工作（36%）和牧师关怀（16%）领域。分析共得出四个主题：（1）以人为本、真诚且文化敏感的护理；（2）疼痛控制；（3）建立信任与联结的方法；（4）理解与种族差异相关的沟通挑战。尽管已投入大量努力培训临床医生进行文化包容性沟通，但我们对临床医生如何应对“现实世界”中结构性少数群体患者表达护理关切的情景仍知之甚少。本研究为识别无意识偏见、制定支持文化包容性沟通的教育干预措施，以及提升少数群体癌症患者临终关怀质量提供了实践启示。
肿瘤(癌症)患者之家