Thank you to Dr. TC
Robbins for an incredibly informative presentation on “Racial Disparities in
End-of-Life Care” last week. If you missed it, I highly recommend watching
it on zoom! Our summary can’t possibly do it justice!
Here are some of the highlights with resources in bold:
- African American and Hispanic patients are more likely to be hospitalized and receive aggressive care in last 6 months of life, and much less likely to use hospice services or have an Advanced Directive.
- Why the racial disparities at the end of life?
Evidence shows this is due to the cumulative impact of bias, mistrust of
providers at the end of life, provider discomfort with non-beneficial
treatment, and language barriers. Consider learning more by reading “Reproductive
Justice” by Ross and Salinger, and “Medical Apartheid” by Harriet Washington.
- Dr. Robbins recommends that we keep in the forefront of our minds the cultural context of our patients’ end-of-life decisions, and check our own bias when we care for our patients. We can start by taking the implicit bias test at https://implicit.harvard.edu
- Dr. Kimberly Curseen from Emory School of Medicine made an interesting recommendation to make a habit of empathy-make it rote-and tells us it will improve the reliability of our care. See her article "Implicit Bias and Its Impact on Palliative Care"
- Another great resource is Stanford University’s series on Cross Cultural Medicine at https://geriatrics.stanford.edu/microlectures.html which includes many helpful videos.
Dr. Robbins gave the following summary points to help us
improve communication at the end of life:
• Don’t enter a conversation with a
specific agenda
• Learn
about the patient, who they are, what gives their life meaning
• Involve
providers who know the patient best (including their PCP if possible)
• Be
thoughtful about the timing of the conversation
• Know
who is in the room and who makes decisions
• Conversation
may occur over multiple visits. Be patient.
• Adjust
for health literacy
• Reduce
medical jargon
• Assess
understanding: “I’ve said a lot, please tell me what you understand in your own
words so I can make sure I’m speaking clearly”
• If
you’re not completely fluent in the patient’s language, use an interpreter for
any serious conversation
•
And as a final point, remember to provide a POLST (in EPIC
using the Advanced Care Planning tab) and Advanced Care Planning https://prepareforyourcare.org/advance-directive-library
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