Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA.
Meta Platforms, Inc., One Hacker Way, Menlo Park, California, USA.
Health Serv Res. 2022 Dec;57 Suppl 2(Suppl 2):263-278. doi: 10.1111/1475-6773.14015. Epub 2022 Jul 18.
To identify communication practices that clinicians can use to address racism faced by Black patients, build trusting relationships, and empower Black individuals in clinical care.
Qualitative data (N = 112 participants, August 2020-March 2021) collected in partnership with clinics primarily serving Black patients in Leeds, AL; Memphis, TN; Oakland, CA; and Rochester, NY.
This multi-phased project was informed by human-centered design thinking and community-based participatory research principles. We mapped emergent communication and trust-building strategies to domains from the Presence 5 framework for fostering meaningful connection in clinical care.
Interviews and focus group discussions explored anti-racist communication and patient-clinician trust (n = 36 Black patients; n = 40 nonmedical professionals; and n = 24 clinicians of various races and ethnicities). The Presence 5 Virtual National Community Advisory Board guided analysis interpretation.
The emergent Presence 5 for Racial Justice (P5RJ) practices include: (1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address bias and structural determinants of health; (2) Listen intently and completely without interruption and listen deeply for the potential impact of anti-Black racism on patient health and interactions with health care; (3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort and consent, and referral planning; (4) Connect with the patient's story, acknowledging socioeconomic factors influencing patient health and focusing on positive efforts; (5) Explore emotional cues by noticing and naming patient emotions, and considering how experiences with racism might influence emotions.
P5RJ provides a framework with actionable communication practices to address pervasive racism experienced by Black patients. Effective implementation necessitates clinician self-reflection, personal commitment, and institutional support that offers time and resources to elicit a patient's story and to address patient needs.
确定临床医生可以用来解决黑人患者面临的种族主义、建立信任关系和增强黑人个体在临床护理中的能力的沟通实践。
定性数据（N=112 名参与者，2020 年 8 月至 2021 年 3 月），与主要为阿拉巴马州利兹、田纳西州孟菲斯、加利福尼亚州奥克兰和纽约州罗切斯特的黑人患者合作收集。
该多阶段项目以以人为中心的设计思维和社区参与性研究原则为指导。我们将新兴的沟通和建立信任策略映射到促进临床护理中有意义联系的存在 5 框架的领域。
访谈和焦点小组讨论探讨了反种族主义沟通和医患信任（n=36 名黑人患者；n=40 名非医疗专业人员；n=24 名不同种族和族裔的临床医生）。存在 5 虚拟国家社区咨询委员会指导分析解释。
新兴的存在 5 种族正义（P5RJ）实践包括：（1）通过反思身份、偏见和权力动态并建立解决偏见和健康结构决定因素的结构来有目的地做好准备；（2）全神贯注地倾听，不要打断，并深入倾听反黑人种族主义对患者健康和与医疗保健互动的潜在影响；（3）通过明确讨论患者目标、治疗舒适度和同意以及转诊计划，就最重要的事项达成一致；（4）通过承认影响患者健康的社会经济因素并关注积极努力，与患者的故事建立联系；（5）通过注意和命名患者的情绪并考虑种族主义经历如何影响情绪，探索情绪线索。
P5RJ 提供了一个具有可操作沟通实践的框架，以解决黑人患者普遍面临的种族主义问题。有效实施需要临床医生的自我反思、个人承诺和机构支持，为患者的故事提供时间和资源，并解决患者的需求。
