Patient-reported racism tied to mistrust, worse patient-clinician communication

Epistemic injustice is the most common manifestation of racism experienced by Black patients with serious illness and is associated with worsened mistrust and negative patient-clinician communication outcomes, according to a study published online July 5 in JAMA Network Open.

Crystal E. Brown, M.D., from the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle, and colleagues examined whether experiences with racism are associated with patient-clinician communication and decision-making among Black patients with serious illness. The analysis included data from semistructured interviews conducted with 25 Black patients with serious illness hospitalized at an urban academic medical center between January 2021 and February 2023.

The researchers found that the participants had substantial socioeconomic disadvantage and reported high levels of medical mistrust and high frequency of discrimination and microaggressions experienced in health care settings. The most common manifestation of racism participants reported was epistemic injustice, including silencing of their own knowledge and lived experiences about their bodies and illness by health care workers. These experiences made participants feel isolated and devalued, especially if they had intersecting, marginalized identities, such as being underinsured or unhoused. These experiences exacerbated existing medical mistrust and poor patient-clinician communication.

"These findings suggest that race-conscious, intersectional approaches may be needed to improve patient-clinician communication and support Black patients with serious illness to alleviate the distress and trauma of racism as these patients near the end of life," the authors write.