(434) Framework to Understand Racial Disparities in End-of-Life Care

Introduction: Currently, recommendations revolve around the standard of care for goal concordant EOL care in the ICU, which is avoiding aggressive care with a focus on palliation once it is deemed that the prognosis is poor.Our objective is to determine whether racial implicit bias exists among ICU clinicians, how Black and Hispanic patients and families who have experienced EOL care in the ICU view clinician racial bias and trustworthiness of clinicians, and whether it impacts their goals of care decisions.

Methods: The central hypothesis will be tested by pursuing three specific aims: 1) Assess the presence of implicit bias among ICU providers by means of a validated questionnaire. To achieve this aim, we will conduct a survey using the Race Implicit Association Test of a sample size of 376 ICU clinicians from the Society of Critical Care Medicine in the United States, to detect the presence of implicit bias about race. 2) Assess Black and Hispanic patient and family EOL experiences and its impact on trust and perceptions about clinician racial bias. To achieve this aim, we will conduct (2.1) a trust questionnaire, using the modification of a validated tool, as well as (2.2) qualitative interviews of 50 Black and Hispanic patients and families, to identify the perspectives of this cohort. We will qualitatively analyze the data to assess any associations with demographics, education, and socio-economic status. 3) Develop recommendations for racially unbiased goal concordant EOL care. To achieve this aim, we will obtain input from an Advisory Committee (consisting of patients, physicians, social workers, ethicists, spiritual care leaders, and community members) to develop (3.1) recommendations to provide greater insight into views of Black and Hispanic patients who receive EOL care in the ICU, and (3.2) develop a future patient experience toolkit that can help clinicians achieve racially unbiased, goal concordant EOL care in the ICU.

Results: This is a proposed framework for an NIH grant. We will share the results at Congress.

Conclusions: The proposed research is significant, because it will involve patient and family voices in explaining the phenomenon seen of disparate EOL care in the ICU and determine which structural and personal characteristics and attitudes should be future interventional targets.