Racial Differences in Shared Decision-Making About Critical Illness.

Area of Science:

• Medical Communication
• Health Disparities
• Critical Care Medicine

Background:

• Shared decision-making (SDM) is crucial for navigating complex treatment choices in critical care.
• Equitable SDM across diverse patient and caregiver populations is not well understood.

Purpose of the Study:

• To compare critical care clinicians' SDM communication patterns with Black and White caregivers.
• To identify racial disparities in clinician-caregiver interactions during critical illness.

Main Methods:

• Thematic analysis of audio-recorded clinician-caregiver meetings from a trial on mechanical ventilation decision aids.
• Analysis included 39 meetings across 13 US intensive care units.
• A codebook focused on SDM components and racial communication disparities; analysts were blinded to caregiver race.

Main Results:

• Four key differences emerged in clinician behaviors based on caregiver race.
• Clinicians offered less emotional support and acknowledged less trust/gratitude from Black caregivers.
• Limited medical information was shared, and Black caregivers' preferences for restorative care were challenged more often.

Conclusions:

• Critical care clinicians missed opportunities to validate emotions and knowledge of Black caregivers compared to White caregivers.
• Findings suggest potential for clinician-level interventions to improve equitable SDM.
• Addressing these disparities is vital for patient-centered critical care.