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      Culturally Centered Palliative Care: A Framework for Equitable Neurocritical Care

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          Abstract

          Health disparities continue to plague racial and ethnic underserved patients in the United States. Disparities extend to the most critically ill patients, including those experiencing neurologic injury and patients at the end of life. Achieving health equity in palliative care in the neurointensive care unit requires clinicians to acknowledge and address structural racism and the social determinants of health. This article highlights racial and ethnic disparities in neurocritical care and palliative care and offers recommendations for an anti-racist approach to palliative care in the neurointensive care unit for clinicians.

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          Most cited references46

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          How does communication heal? Pathways linking clinician-patient communication to health outcomes.

          Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions. Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway. Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.
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            Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.

            Black Americans are systematically undertreated for pain relative to white Americans. We examine whether this racial bias is related to false beliefs about biological differences between blacks and whites (e.g., "black people's skin is thicker than white people's skin"). Study 1 documented these beliefs among white laypersons and revealed that participants who more strongly endorsed false beliefs about biological differences reported lower pain ratings for a black (vs. white) target. Study 2 extended these findings to the medical context and found that half of a sample of white medical students and residents endorsed these beliefs. Moreover, participants who endorsed these beliefs rated the black (vs. white) patient's pain as lower and made less accurate treatment recommendations. Participants who did not endorse these beliefs rated the black (vs. white) patient's pain as higher, but showed no bias in treatment recommendations. These findings suggest that individuals with at least some medical training hold and may use false beliefs about biological differences between blacks and whites to inform medical judgments, which may contribute to racial disparities in pain assessment and treatment.
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              Structural Racism In Historical And Modern US Health Care Policy: Study examines structural racism in historical and modern US health care policy.

              The COVID-19 pandemic has illuminated and amplified the harsh reality of health inequities experienced by racial and ethnic minority groups in the United States. Members of these groups have disproportionately been infected and died from COVID-19, yet they still lack equitable access to treatment and vaccines. Lack of equitable access to high-quality health care is in large part a result of structural racism in US health care policy, which structures the health care system to advantage the White population and disadvantage racial and ethnic minority populations. This article provides historical context and a detailed account of modern structural racism in health care policy, highlighting its role in health care coverage, financing, and quality.
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                Author and article information

                Contributors
                mageep@chop.edu
                Journal
                Neurocrit Care
                Neurocrit Care
                Neurocritical Care
                Springer US (New York )
                1541-6933
                1556-0961
                2 July 2024
                2 July 2024
                2024
                : 41
                : 3
                : 760-766
                Affiliations
                [1 ]Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, ( https://ror.org/01z7r7q48) 3401 Civic Center Blvd, 9 Main Suite 9NW45, Philadelphia, PA 19104 USA
                [2 ]Division of Critical Care Medicine, Children’s National Hospital, ( https://ror.org/03wa2q724) Washington, DC USA
                Author information
                http://orcid.org/0009-0008-2939-7554
                Article
                2041
                10.1007/s12028-024-02041-y
                11599620
                38955929
                783ae714-dcfc-4f1c-9c0a-7122b0e2fecc
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 April 2024
                : 31 May 2024
                Categories
                Palliative Care in the Neuro Intensive Care Unit
                Custom metadata
                © Neurocritical Care Society and Springer Science+Business Media, LLC, part of Springer Nature 2024

                Emergency medicine & Trauma
                equity,neurocritical care,palliative care,disparities,racism,social determinants of health

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