Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Health Forum. 2024 Mar 1;5(3):e240046. doi: 10.1001/jamahealthforum.2024.0046.
Numerous Black individuals experience racism persistently throughout their lives, with repercussions extending into health care settings. The perspectives of Black individuals regarding emergency department (ED) care, racism, and patient-centered approaches for dismantling structural racism remain less explored.
To qualitatively explore the perspectives and experiences of Black patients related to race, racism, and health care following a recent ED visit.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, the audio from semistructured interviews of Black patients discharged from an academic urban ED between August 2021 to April 2022 were recorded, transcribed, and analyzed using thematic analysis.
The main outcomes encompassed the main themes from the analysis of the interviews with Black patients regarding their perspectives on race, racism, and clinical care.
A total of 25 Black patients (20 [80%] female; mean [SD] age, 44.6 [12.9] years) discharged from the ED were interviewed. Three broad domains were identified: (1) racism in health care; (2) ED clinical care; and (3) recommendations for improvement. Within these domains, the first 2 were grouped into specific themes. Within the first domain, racism in health care, 7 themes were identified using thematic analysis: (1) a history of medical racism; (2) dismissiveness; (3) patient expectations on encountering racism; (4) medical mistrust; (5) health literacy; (6) postencounter outcomes, and (7) discrimination beyond but associated with race. Within the second theme, ED clinical care, 5 themes were identified using the same thematic analysis method: (1) discharge plan; (2) patient experience; (3) waiting room perceptions; (4) medication treatment; and (5) pain management. The third domain, recommendations for improvement, incorporated patient-generated suggestions for enhancing the Black patient experience.
In this qualitative study, the fabric of clinical care delivery in the ED was intricately woven with Black patients' experiences of racism. Patients expressed a pervasive sense of mistrust, skepticism, and dismissiveness at the system level. Instances of racism were consistently highlighted by patients from their entry to the ED to discharge. These perspectives illuminate the pervasive nature of racism in clinical care, providing valuable insights for exploring patient-centered approaches to foster antiracist cultures in the ED and throughout the broader medical landscape.
许多黑人个体在其一生中持续经历种族主义，其影响延伸至医疗保健环境中。黑人个体对急诊部（ED）护理、种族主义以及用于消除结构性种族主义的以患者为中心的方法的看法仍然较少被探索。
定性探讨黑人患者在最近一次 ED 就诊后与种族、种族主义和医疗保健相关的观点和经历。
设计、环境和参与者：在这项定性研究中，记录了 2021 年 8 月至 2022 年 4 月期间从一所学术性城市 ED 出院的黑人患者的半结构式访谈的音频，转录并使用主题分析进行分析。
主要结果包括从对黑人患者的访谈中分析得出的关于他们对种族、种族主义和临床护理的看法的主要主题。
共对 25 名从 ED 出院的黑人患者（20 名[80%]女性；平均[标准差]年龄，44.6[12.9]岁）进行了访谈。确定了三个广泛的领域：（1）医疗保健中的种族主义；（2）ED 临床护理；和（3）改进建议。在这些领域内，前两个领域被分为具体主题。在第一个领域，医疗保健中的种族主义，使用主题分析确定了 7 个主题：（1）医疗种族主义的历史；（2）轻视；（3）患者对遇到种族主义的期望；（4）医疗不信任；（5）健康素养；（6）遭遇后的结果，和（7）与种族相关但超出种族的歧视。在第二个主题，ED 临床护理，使用相同的主题分析方法确定了 5 个主题：（1）出院计划；（2）患者体验；（3）候诊室看法；（4）药物治疗；和（5）疼痛管理。第三个领域，改进建议，纳入了患者提出的增强黑人患者体验的建议。
在这项定性研究中，ED 中临床护理的提供方式与黑人患者的种族主义经历紧密交织在一起。患者在系统层面上表达了普遍的不信任、怀疑和轻视感。患者始终强调他们在进入 ED 到出院期间遇到的种族主义事件。这些观点阐明了种族主义在临床护理中的普遍存在，为探索以患者为中心的方法提供了有价值的见解，以在 ED 乃至更广泛的医疗领域培养反种族主义文化。
