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Health care professionals work to address inequities in palliative care – State of Reform

A diverse panel of health care professionals considered approaches to addressing inequities in end-of-life care Friday.

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The Washington State Medical Association hosted the panel, which featured Dr. Devyani Chandran, Dr. Mabel Bodell, Dr. Raleigh Bowden, and Eze Oluo. Prior to the panel discussion, Dr. Edwin LindoAssociate Dean for the Office of Healthcare Equity at the University of Washingtondiscussed several factors that contribute to racial disparities in end-of-life care, including preferences in languages, religious beliefs, preferences in treatment, and quality of care.

“If you look at the data, Black, Latino, and other nonwhite folks are less likely to talk about end-of-life plans, receive pain management, and are more likely to have invasive end-of-life procedures,” Lindo said . “The job you all have is tremendously difficult. You are in many ways the last stop for that individual. That’s a large obligation and responsibility. When we see patients that are perhaps angry, agitated, or confrontational, it isn’t actually you. It is the historical legacy of the experience these folks had.”

Growing evidence suggests that racial and ethnic disparities exist in access to palliative care and in clinical outcomes such as symptom management and communication, according to the Journal of Palliative Medicine.

Bowden, Director of the Okanogan Palliative Care Initiative, said building trust is the most important element in communicating the importance of palliative care in the Native populations she works with. Sharing meals is a good way to open dialogue, she said.

“In our Okanogan program, we invited [Native community representatives] to lunch at the casino,” Bowden said. “They wanted to share what palliative care meant to them. They said, ‘We need help with resources so we can do our work better.’ So we looked for ways to provide them with connections to resources and learned from them what they needed. Now they are coming back to us to ask more questions.”

Bodell, a Nephrologist at Confluence Health in Wenatchee, said forming partnerships with grassroots organizations is important. That was the approach she used to inform Wenatchee Hispanic populations about the importance of COVID-19 vaccinations, she said.

“We asked our community partners to join us [and asked] how to bring the vaccines to the community,” Bodell said. “We talked about our limitations, we partnered with them, and started to work hard. Most [community members] didn’t have a smartphone to sign up for the vaccine.”

Members from local grassroots organizations went door-to-door to get community members signed up for vaccines and received a large turnout, Bodell said.

“Now we are focusing on other health disparities and talking about end-of-life care,” Bodell said.

Oluo, a Program Manager at Washington Permanente Medical Group Administration, said understanding different cultures is important. He is African, and said people from African cultures appreciate it when health care officials understand their religious preferences.

“We see ourselves and our bodies as sacred,” Oluo said. “End-of-life care for us is just a transition to a higher glory. There are very stringent rituals that accompany that. when [a health care professional] is not able to understand the nuances of that culture, it prohibits them from offering culturally competent care.”

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