TY - JOUR
T1 - Problematic Integration
T2 - Racial Discordance in End-of-Life Decision Making
AU - Drummond, Darlene K.
AU - Kaur-Gill, Satveer
AU - Murray, Genevra F.
AU - Schifferdecker, Karen E.
AU - Butcher, Rebecca
AU - Perry, Amanda N.
AU - Brooks, Gabriel A.
AU - Kapadia, Nirav S.
AU - Barnato, Amber E.
N1 - Publisher Copyright:
© 2022 Taylor & Francis Group, LLC.
PY - 2023
Y1 - 2023
N2 - We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients’ religion and support systems; (3) epistemological uncertainty as ambivalence in which providers’ feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients.
AB - We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients’ religion and support systems; (3) epistemological uncertainty as ambivalence in which providers’ feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients.
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U2 - 10.1080/10410236.2022.2111631
DO - 10.1080/10410236.2022.2111631
M3 - Article
C2 - 35981599
AN - SCOPUS:85136219611
SN - 1041-0236
VL - 38
SP - 2730
EP - 2741
JO - Health Communication
JF - Health Communication
IS - 12
ER -