Honoring the Legacy of your Black/African American Patients Starts by Asking the Right Questions

Asking the right questions (and actively listening to the answers) can help: 

As healthcare providers, it is our obligation to explore ways to address the unique cultural needs of our patients in order to improve their quality of care. Every patient and their family have their own needs that are specific to them as individuals. Today we’ll explore a list of five questions you can ask that will help you address your patient’s cultural needs. These questions become even more important for patients with chronic or serious illness who may soon be eligible for the support hospice can provide. 

1. What is the best way that I can partner with you and your family?
2. Are there any previous experiences with healthcare providers that weigh upon you? Positively or negatively? 
3. How do you view medication? Are there differences between your views and those of your family? 
4. Is there something that is key to your quality of life (ex. like when someone has to perform personal care for you or when you aren’t able to knit anymore), that when no longer possible would indicate a time to focus on discussing your final wishes? 
5. Who would you like to be involved in discussions and decision-making?  Are there any members of your community that should be involved in meetings to support you and your family’s needs (i.e. clergy)? 

A case study: Mr. J

With the 5 questions above in mind, consider the following case study: 

Mr. J is a 76-year-old widowed Black man, with a hospice-eligible diagnosis of end-stage congestive heart failure. Mr. J lives in a community-based assisted living facility. His daughter lives 20 minutes away with her family. Mr. J is on continuous oxygen via nasal canula and is unsteady on his feet. Mr. J has trouble sleeping due to chronic cough. At night, he needs to have his head elevated and uses a full face mask for a “good night’s sleep.” He suffers from persistent acute back pain yet refuses pain medication. Due to increased dyspnea, while on oxygen with minimal exertion, Mr. J meets the requirements to become eligible for hospice services. 

Mr. J is generally outgoing and a beloved member of his community where he and his family have lived for over 30 years. Mr. J is a former Deacon in his church and is retired from the U.S. Army; he served in active combat in Vietnam.  Mr. J is suspicious of strangers and does not have experience with a consistent primary care physician.  

How person-centered care can provide higher-quality outcomes: 

Now that you’ve learned about Mr. J, how may his answers to those questions impact the care provided? Take a moment to list 5 facts about Mr. J that stand out to you. Now, let’s assume we’ve developed an individualized plan of care for Mr. J that provides care in accordance with his answers: 

Upon admission to hospice, Mr. J shares that spending time outside playing cards with his neighbors brings him great joy and adds to his quality of life. Mr. J loves to shake a tambourine and enjoys his visits with his Board-Certified Music Therapist, she plays all his favorite hits! As a former Deacon, his faith is incredibly important to him, and Mr. J would like Reverend Jenkins to be involved in discussions around advance care planning. His hospice team has contacted Reverend Jenkins to ensure he’s involved. Mr. J and his family were very touched when his hospice team completed a We Honor Veterans pinning ceremony that was featured on the local news!  

Taking Mr. J’s experience into consideration, what updates can you make to your approach to meet your patient’s needs? The more you know about your patients—those special details that truly make them who they are—the higher the probability that they will feel honored and cared for at the end of life. 

Barriers Still Exist. Even though hospice consistently achieves higher quality outcomes for patients while saving Medicare dollars, there are still massive inequities in utilization. According to the most recent facts and figures from the National Hospice & Palliative Care Organization, only 8.2% of the Medicare beneficiaries who utilized their hospice benefits in 2018 identified as Black/African American. 

There are several reasons that contribute to this low utilization. Part of the issue stems from a mistrust in the healthcare system due to historical disparities in care quality and outcomes. There can be misconceptions that patients and families may have around hospice such as forgoing benefits they are entitled to under Medicare. 

Hospice programs bear some responsibility as well. The community has acknowledged disparities in recent years and is working to combat these via programs like the National Hospice & Palliative Care Organization’s Quality Connections program, which includes core quality measures aimed at promoting diversity, equity, and inclusion within a hospice program and the patients and families they serve. 

When considering these barriers to care, the solutions to helping each and every patient access high-quality hospice care is to build trust with patients and their support system. Hospice providers know that patients who use hospice care experience an increase in quality of life for them and their loved ones, and the statistics demonstrate same. The obligation is on us to understand the needs of the Black/African American community, during Black History Month and every other day of the year. 

Learn how hospice added to Miss Artie's quality of life