Equity-based narratives in physician-family conversations about goals of care

During conversations about the goals of care, clinicians sometimes use communication strategies that are inadequate for promoting shared decision making. Instead of jointly constructing an equity-based narrative of the patient's illness with the family, clinical care teams often treat the patient as if they are abstracted from their cultural, social, and family background. This approach to decision making fails to account for health inequities and cultural differences while reinforcing asymmetrical power dynamics that favor the health care team and institution.

After reviewing the literature on health communication and health equity, we determined that language, particularly the use of metaphors, can reinforce systems of power that benefit clinical care teams, often at the expense of patients and their families.

In this article, we offer a novel approach to these conversations that considers tensions between the frames of the dominant narrative of individualism used by clinicians who see a patient in abstraction from systems and an equity-based narrative that is concerned with those systems and their impacts on the patient.

This article offers some guidance for clinicians on how to craft goals of care conversations in ways that are meaningful to patients and families while enhancing communication and promoting shared decision making. While this article focuses on a specific discussion about caring for a patient in the intensive care unit, the approach offered here could be applied to any goals of care conversation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).