Getting on "the same page": a qualitative study on strategies for healthcare professionals in cross-cultural communication about serious neurological illness.

BACKGROUND

Serious illness communication with racial and cultural discordance can be challenging for both patients and providers. Furthermore, patients with serious neurologic conditions may have deficits that affect communication and medical decision-making. We aimed to explore strategies for effective culturally-tailored communication and interpersonal relationship-building that multidisciplinary healthcare providers use to facilitate serious illness conversations with patients of diverse cultural backgrounds.

METHODS

Using non-stratified purposive and snowball sampling, we conducted semi-structured interviews with 17 multidisciplinary providers, recruited from an academic tertiary care center, a Veterans Affairs hospital, and an academia-affiliated county hospital, who provide care for patients with serious neurologic conditions. We used inductive and deductive content analysis methods with dual review. We used inductive and deductive content analysis methods with dual review.

RESULTS

We describe six strategies providers used to establish trust and rapport with diverse patients and families. Theme 1: Recognize and check personal biases about race and culture. Theme 2: Create sufficient time and space to build connection with patients and families. Theme 3: Ask direct, open-ended questions to gather clear information about lived experiences and establish rapport. Theme 4: Repeat information as necessary to ensure understanding and bi-directional engagement. Theme 5: Understand family structure and dynamics and involve family members in communication and decision-making. Theme 6: Partner with palliative care teams, interpreters and other hospital staff as well as individuals from outside the healthcare system.

CONCLUSIONS

High-quality care involves culturally-sensitive and tailored communication, which can be challenging for patients with neurocognitive deficits and limited abilities in communication and decision-making. Our study highlights six ways on how to establish rapport and improve cross-cultural serious illness communication with these diverse patients and families.