The Presence 5 for Racial Justice Framework for anti-racist communication with Black patients

Objective: To identify communication practices that clinicians can use to address racism faced by Black patients, build trusting relationships, and empower Black individuals in clinical care. Data Sources: Qualitative data (N = 112 participants, August 2020-March 2021) collected in partnership with clinics primarily serving Black patients in Leeds, AL; Memphis, TN; Oakland, CA; and Rochester, NY. Study Design: This multi-phased project was informed by human-centered design thinking and community-based participatory research principles. We mapped emergent communication and trust-building strategies to domains from the Presence 5 framework for fostering meaningful connection in clinical care. Data Collection Methods: Interviews and focus group discussions explored anti-racist communication and patient-clinician trust (n = 36 Black patients; n = 40 nonmedical professionals; and n = 24 clinicians of various races and ethnicities). The Presence 5 Virtual National Community Advisory Board guided analysis interpretation. Principal Findings: The emergent Presence 5 for Racial Justice (P5RJ) practices include: (1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address bias and structural determinants of health; (2) Listen intently and completely without interruption and listen deeply for the potential impact of anti-Black racism on patient health and interactions with health care; (3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort and consent, and referral planning; (4) Connect with the patient's story, acknowledging socioeconomic factors influencing patient health and focusing on positive efforts; (5) Explore emotional cues by noticing and naming patient emotions, and considering how experiences with racism might influence emotions. Conclusion: P5RJ provides a framework with actionable communication practices to address pervasive racism experienced by Black patients. Effective implementation necessitates clinician self-reflection, personal commitment, and institutional support that offers time and resources to elicit a patient's story and to address patient needs. KEYWORDS African American, Black, communication, community-based participatory research, design thinking, human-centered design, patient care, qualitative What is known on this topic * Effective communication that mitigates pervasive racism is central to the delivery of high-quality and equitable care for Black patients. * In the clinical setting, Black patients frequently face overt racism, as well as unconscious biases that negatively impact care. * Anti-racism is a core aspect of Professionalism from the Accreditation Council for Graduate Medical Education (ACGME), which calls for discussion-based frameworks to support clinicians in anti-racist communication and trust-building. What this study adds * The Presence 5 for Racial Justice (P5RJ) framework incorporates human-centered design and community-based participatory research strategies, and input from patients, clinicians, previous literature, and nonmedical professionals. * P5RJ focuses on clinician self-reflection and awareness of personal biases, interpersonal communication practices focused on empathy, and institutional anti-racist practices promoting team-based care and additional time with Black patients. * Listening was at the core of Black patients' requests, including active listening in one-on-one encounters, as well as listening for cues about the impact of anti-Black racism on patient health.
1 | INTRODUCTION In 2021, the US Centers for Disease Control formally recognized racism as a fundamental threat to health, (1) a legacy of 400 years of systemic racism through [...]