Listening to many voices: qualitative perspectives of Black and Latino community health center patients on serious illness communication.

Abstract

To elucidate perspectives of Black and Hispanic/Latino patients to improve serious illness communication (SIC) delivery at a community health center. The benefits of serious illness communication (SIC) are well described, though access to effective and culturally appropriate SIC remains inequitable. Individuals from historically marginalized communities participate less in advance care planning, experience lower-quality communication, and feel less understood by clinicians. Making SIC more accessible for all patients is an important goal. Focus groups were conducted virtually and audiorecorded, with sessions available in both English and Spanish. Participants were Black and Hispanic/Latino patients over 40 years old of varying health status who received care at a community health center in the greater Boston area, an urban metropolitan area. Data were analyzed using hybrid deductive-inductive thematic analysis by an interprofessional, multilingual research team. Focus groups were conducted with 24 participants: 15 (63%) female, 13 (54%) Hispanic/Latino, 11 (46%) non-Hispanic Black; 14 (58%) English-speaking and 10 (42%) Spanish-speaking. Nearly 40% (9) of participants had no self-reported comorbidities, while 8 (35%) had 2 or more comorbidities. Mean age was 55 years (range 42-73). WE IDENTIFIED FOUR FACTORS THAT CAN INFLUENCE SIC ENGAGEMENT: (1) prior exposure to SIC increases desire to engage in SIC; (2) communication context (e.g., timing, conversation setting, how the conversation is introduced) can set up SIC for success; (3) aspects of a clinician-patient therapeutic relationship (e.g., empathy, competence) facilitate trust-building and SIC engagement; and (4) personalized adaptations to linguistic, cultural, religious/spiritual, and information-sharing preferences are critical. This study highlights dimensions of SIC requiring an approach personalized to the patient's background and preferences. Future interventions should support primary care practices in integrating these approaches. Based on study findings, we introduce practical, clinically focused communication skills before and during SIC to promote trust-building and quality communication.