Listening to Many Voices: Serious Illness Communication Preferences Among Black and Latino Patients

Outcomes 1. Describe the inequities in access to effective and culturally appropriate serious illness communication for historically marginalized populations.2. Highlight findings of a qualitative study focused on understanding how Black, Hispanic/Latino, and Spanish-speaking patients prefer to have serious illness conversations. Key Message Historically marginalized individuals participate less in advance care planning, experience lower-quality communication, and feel less understood by clinicians. We conducted focus groups with Black, Hispanic/Latino, and Spanish-speaking patients to elucidate preferences to improve serious illness communication and advance care planning. Four themes emerged as elements of quality serious illness conversation. Introduction  The benefits of serious illness communication (SIC) are well described,[1-2] though access to effective and culturally appropriate SIC is inequitable.[3] Historically marginalized individuals participate less in advance care planning (ACP), experience lower-quality communication, and feel less understood by clinicians.[4-5] Systemic racism, mistrust, and structural inequities contribute to inequities.[1] It is not known how to optimize SIC/ACP for Black and Hispanic/Latino patients. Objective To elucidate preferences of Black and Hispanic/Latino patients to improve SIC/ACP delivery at a community health center. Methods  Focus groups were conducted virtually in English and Spanish with Black and Hispanic/Latino patients who receive care at a community health center in a New England urban metropolitan area. Transcripts were analyzed using thematic coding and themes refined by interprofessional, multilingual research team. Results  Focus groups were conducted with 24 participants: 15 women (63%), 13 Hispanic/Latino (54%), 11 non-Hispanic Black (46%), and 10 (42%) Spanish-speaking. Mean age was 55 years (range 42-73). Prior to study, two participants had completed ACP documentation, and one had had an SIC with their clinician. Four elements of quality SIC emerged: (1) there are specific aspects of a therapeutic relationship (e.g., empathy, competence), that facilitate trust-building and SIC/ACP engagement; (2) many individuals had prior exposure to SIC/ACP through personal/family experience, which positively influences their desire to engage in SIC; (3) to set up a successful SIC, clinicians should consider factors including conversation triggers, emotional support, and whether family or friends should be present; and (4) individual factors including language, culture, faith, family dynamics, and information preferences influence how people want to engage with SIC/ACP, so clinicians should ask the individual their preferences. Conclusion  This study explores how to tailor SIC to patient preferences to promote equitable access. Future interventions should support primary care practices in engaging patients in high-quality SIC. Keywords Diversity, Equity, Inclusion, Belonging, Justice / Communication