Addressing healthcare bias in caring for patients with sickle cell disease

Abstract

Patients experiencing acute pain episodes from sickle cell disease (SCD) frequently present to our ED, but the staff seem reluctant to administer I.V. analgesia. What is the best approach to advocate for these patients?Christianne Marr; Daniel Schmitgal; and Bridget Parsh, EdD, MSN, RN, CNS reply: SCD is a group of inherited blood disorders that affect the red blood cells, turning normal, flexible "disc" shaped cells into the shape of a "C" or a sickle. 1 These misshapen cells become rigid and can occlude small blood vessels, causing acute vaso-occlusive pain episodes. 1 Other, more serious complications include acute chest syndrome (defined as a new radiodensity on chest imaging accompanied by fever with or without respiratory symptoms), tissue ischemia, and even death. 1 SCD is more common in certain ethnic groups, including people of African descent; Hispanics from Central and South America; and people of Middle Eastern, Asian, Indian, and Mediterranean descent. 1 In addition, those affected by SCD often face disease-related stereotypes and biases in healthcare settings. 2 Addressing healthcare bias in caring for patients with sickle cell diseaseBecause 90% of patients with SCD in the US are Black, the connection of race to many of the disparities experienced by these patients cannot be ignored. 2

Individuals with Sickle Cell Disease Using SBAR as a Communication Tool: A Pilot Study

“…Patients with SCD face unique challenges during care seeking for pain management in emergency departments. These challenges have been described by patients and HCPs [ 4 , 6 , 7 , 8 , 10 , 13 , 14 , 15 , 16 , 18 , 19 ]. The current study results support using SBAR as a communication tool for patients to communicate with providers in the emergency department.…”

“…Although not the focus of this paper, the role of race in some of these perceived barriers must be considered, given that most people in the US with SCD are Black [ 2 ]. Topics such as racial bias in caring for patients with SCD [ 14 ], roots of distrust in healthcare due to racism [ 15 ], and racialized disparities in pain management [ 16 ] are important considerations.…”

“…Despite the racial challenges, nurses and other HCPs play a significant role in advocating for patients with SCD [ 14 ]. However, for HCPs to be the best advocates for individuals with SCD, the patients with SCD need to communicate their needs to decrease the bias.…”