Communication for Equity in the Service of Patient Experience: Health Justice and the COVID-19 Pandemic

Abstract

Health professionals are responding to the coronavirus disease 2019 (COVID-19) pandemic with Herculean effort and a desire to provide high quality care for all. As is true with any intervention, one size does not fit all. Differences matter. Communicating across differences is a complex skill set that is necessary for high quality care.Reports in print and online media indicate disparate outcomes for patients who identify as Black/African American, Native, and Latinx (1). Long-standing inequities are at the root of these disparities. For example, Black and Latinx communities have fewer options for working from home and higher rates of diabetes than other racial/ethnic groups, factors that are associated with higher risk of infection and greater mortality (2,3). In Chicago, "Black residents accounted for 72% of deaths from COVID-19 complications in the city and 52% of positive tests for the coronavirus, despite making up only 30% of the city's population, according to the city's public health agency"(4). Additionally, a diversity of language preferences impacts health care at a time when conversations about prevention, treatment, and advanced directives are vital.Communication that fosters equity is essential in mitigating interpersonal bias (5). Importantly, this does not exempt the reader from the responsibility of remedying structural inequities within health care institutions and society at large. We also acknowledge that no document, regardless of how well-meaning, could fully address the needs of health care team members in recognizing and mitigating interpersonal bias during this pandemic.Here, we offer a brief guide that may improve patient engagement across differences. The authors recognize that health care workers possess a wide range of awareness and expertise. For those who are new to this work, we hope to offer practical tools for communication that can mitigate interpersonal bias. For those with greater awareness of bias, we hope this guide will serve as a reminder of the importance of consistently applying these tools in times of crisis. Health care providers have displayed bravery in this pandemic. We are hopeful that this courage will extend to a willingness to engage in more effective communication to mitigate disparate COVID-19 outcomes.

Opportunities to improve COVID-19 provider communication resources: A systematic review

“…A variety of communication topics were covered in the articles, with the most prevalent topic a general emphasis on patient communication (25%) where lessons learned were highlighted [ 59 , 64 , 71 , 75 , 80 , 92 ], barriers [ 96 ] and resources [ 58 ] shared culture humility [ 61 ] and equitable care [ 63 ] addressed, and communication in palliative care settings emphasized [ 62 , 65 , 101 ]. Goals of care discussions and telehealth were the next most common communication topics (13%, respectively).…”

Making science communication inclusive: an exploratory study of choices, challenges and change mechanisms in the United States from an emerging movement

“…Our findings demonstrate the desire among practitioners for clarity on the range of evaluative mechanisms they might use, the guiding principles or frameworks they might apply [e.g., those of Garibay & Teasdale, 2019;Lehr et al, 2007;Jensen & Gerber, 2020;Murray-Johnson, 2019, or others], and, especially, new evaluation models that are far more collaboratively designed. These models require attention and sensitivity to ISC's many moving contexts, and a transdisciplinary approach that builds on learning from other fields that, for example, can offer insights about critical dialogue [Calabrese Barton & Tan, 2020;Cordero & Davis, 2020;Mauldin, 2014;Garfinkel, 2004;Zúñiga et al, 2012]. There is also a clear need for longitudinal studies that follow ISC efforts -in specific contexts and with specific goals over time -rather than the typical model that has relied on one-time efforts with time-bound funding.…”