PCR057: Presence for Racial Justice: Disrupting racism through physician-patient communication

Cati Brown-Johnson, PhD; Megha Shankar, MD; Juliana Baratta, MS; Gisselle De Leon, BS; Raquel Garcia, BA; Taylor Hollis; Jonathan Shaw, MD, MS; Mae-Richelle Verano; Kelsey Henderson; Mauranda Upchurch, MS; Sonoo Thadaney Israni, BA, MBA; Donna Zulman, MD, MS; Nicholas Kenji Taylor, MD, MSc; Nadia Safaeinili, MPH; Joy Cox

Abstract

Context: Anti-Black racism is firmly rooted in US healthcare, but many clinicians do not have the tools and language to question their biases and address racism in clinical practice, eg biased communication practices such as “non-compliance” in medical documentation.
Objective: Presence 5 for Racial Justice (P5RJ) leverages the Presence 5 patient-provider communication framework to identify anti-racism communication practices that support trusting relationships between physicians and Black patients and empower Black individuals in clinical care. Study design: For this multi-phased community-based participatory research (CBPR) overseen by an advisory board of clinicians and patients at four community clinics, we conducted a literature review, interviews with Black patients, clinician small-group discussions, and design thinking interviews with non-medical professionals. We mapped emergent communication practices to Presence 5 domains to create P5RJ.
Setting: Four primary care clinics primarily serving Black patients in Oakland CA; Rochester NY; Leeds AL; Memphis TN.
Population Studied: Total 113 participants (40 non-medical interviews, 37 Black patients interviewed, 12 advisory board members, 24 clinicians in discussion); 30 reviewed articles.
Outcomes: Strategies on how providers, through communication and connection in the clinical visit, can navigate and address structural, institutional, and personally mediated forms of racism faced by Black patients.
Results: P5RJ practices included: 1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address emergent bias and social determinants of health; 2) Listen intently and completely by using focused interpersonal listening without interruption and deep listening for racism impacts; give patients time and space to tell their story; 3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort, consent, and referral planning; 4) Connect with the patient’s story by acknowledging socio-political factors influencing patient health and focusing on positive efforts/events to encourage patient agency; 5) Explore emotional cues by noticing and naming patient emotions and considering how racial trauma might influence these emotions.
Conclusion: P5RJ practices offer strategies to reflect on clinician biases, address racism and known gaps in care for Black patients and promote health equity in their clinical care.
Leave a Comment
Jack Westfall
jwestfall@aafp.org 11/20/2021

thanks for your work and poster presentation.

Diane Harper
harperdi@med.umich.edu 11/21/2021

interesting work. nice way to collaborate across the nation.

Ann Macaulay
ann.macaulay@mcgill.ca 11/22/2021

such very important work

Emily Godfrey
11/22/2021

Great work. Beautiful poster design. Appreciate the clear and simple presentation. thank you!

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/23/2021

This is such important topic - we need to think about how to get this into practice more routinely. Thanks for your work on this.

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Love the abstract and the topic. So very important. I don't know if it's just me but given the virtual format, it's a bit tough to see the poster

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