April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Problematic Integration: Racial Discordance in Provider End-of-Life Advice to African-American Cancer Patients and Their Families
Background: End-of-life (EOL) discussions are an important type of conversation in which support is enacted between a cancer patient and his or her healthcare provider(s). Providers enact informational support by giving advice and presenting new perspectives on a problem, while family members enact emotional support by being there as bad news is delivered. Providers do an inadequate job of explaining illness, are less supportive of, give less information to, and spend less time with African American patients. Biases contribute to these behaviors resulting in negative health outcomes for African Americans. Objective: Our primary objective was to identify and describe provider perceptions of African American cancer-patients’ support systems and how those perceptions influence EOL advice given; and identify the communication strategies providers employ. Methods: We examined 57 pre-coded formal semi-structured provider interviews conducted across three different U. S. cancer centers. Thirty-five providers were oncologists and the rest hospitalists, supportive/palliative, emergency medical, ICU, and clinical psychologists. Fifty-four were non-Black and three Black.We applied problematic integration theory (PIT) to the transcripts by coding probabilistic and evaluative orientations, and problematic situations described by providers to learn how they made sense of managing a patient with advanced cancer. Findings: Generally, situations in which giving EOL advice is not problematic and satisfying for providers include instances when the provider is able to speak directly with the patient, colleagues are available to assist the provider, and when family members are present. However, the African American family is a source of anxiety and fear for many providers representing instances of uncertainty, divergence, ambivalence and impossibility. Problematic situations result in (1) ontological uncertainty in which providers characterize the nature of African Americans as one of “mistrust;” (2) an ontological-epistemological uncertainty in which a lack of education is viewed as the norm for both providers and patients; (3) divergence in which the goals of the provider and family do not align; (4) epistemological uncertainty as ambivalence in deciding whether or not to converse with family members, and (5) ontological uncertainty as impossibility when patient “mistrust” is viewed as hopeless. Some of the communication strategies providers use in attempting to resolve these problems include indirect stereotyping, bargaining, negotiating, and blame-guilt framing. Conclusions: This study assists in filling a gap in the medical and health communication literature on underserved and understudied populations, specifically African American patients with advanced cancer. Most studies on uncertainty in healthcare focus on the patient while this one is on the provider. It contributes to the development of PIT by demonstrating how one problematic form can transform into another (i.e., epistemological uncertainty as ambivalence).