Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities.

356 Background: Lack of patient engagement around the content and approach to care conversations related to social determinants of health (SDOH) can negatively impact healthcare experiences and exacerbate disparities in outcomes. Lived environment, financial/logistical challenges, general access barriers and patient mistrust must be addressed on a systemic and individual level. Assumptions based on socioeconomic status, age, race, gender, and medical conditions can undermine communication and/or invalidate a patient's feelings and lived experiences. Accelerating the requirement of SDOH screenings without addressing the patient-centeredness of these conversations will likely contribute to health inequities and yield substandard patient experiences and outcomes. Methods: To better understand patient perspectives about language commonly used in SDOH screenings, we gathered views on terminology used towards patients through surveys, focus groups, and virtual workshops. Participants were recruited from a diverse pool of insured patients served by Patient Advocate Foundation representing various medical diagnoses, were lower income (<$48,000), racially/ethnically reflective of the US, and experienced healthcare access and/or affordability challenges. Results: Patients had both positive and negative perspectives on SDOH screening in clinical settings, specifically focused on communication, bias, and privacy. Survey/focus group results revealed the discomfort of financial and non-medical information (SDOH) being included in their electronic medical record (EMR). “It’s important to find words that are less stigmatizing because it affects how we see ourselves and others.” Only 21% reported being extremely comfortable with SDOH information being recorded in their EMR and subsequently being available to multiple members of their healthcare team. Judgement, embarrassment, shame, and lack of action (i.e., linkage to resources) were often cited as reasons for not wanting to have uncomfortable conversations. Patients also felt that disclosing this information could (or would) influence the treatment options offered, creating bias solely regarding their perceived ability to manage their medical and non-medical financial obligations. Conclusions: We uncovered how, without patient engagement, language and processes the healthcare system uses can feel biased and stigmatizing to those it is designed to help. Stigmatizing conversations can perpetuate discriminatory attitudes, influence clinicians' decision-making when treating a patient, and affect patient trust and disclosure within care settings. This cycle impacts quality of care and contributes to health disparities. By listening to patient perspectives, researchers and health care professionals can become more culturally aware and reduce stigmatizing language, while making care more patient-centric and inclusive.