People with Serious Illness Experience Healthcare Inequities in Patient-Clinician Communication

Outcomes 1. Describe the prevalence of certain communication-related healthcare experiences from a large, nationally representative sample of US adults. 2. Highlight that people with serious illness are more likely to have negative communication-related healthcare experiences that clinicians should recognize to communicate and care for them more effectively. Key Message We sought to understand communication-related health experiences for people with and without serious illness. People with serious illness were more likely to report leaving a visit feeling unsure, being afraid to ask questions, and feeling talked down to than those without serious illness. This demonstrates people with serious illness experience inequities in communication and highlights the importance of empathetic communication. Introduction/Context High quality communication is critical to the well-being and quality of life of those facing serious illness.[1,2] How people with serious illness engage in care and their care experience is different compared to those without serious illness.[3] We sought to better understand communication-related health experiences of individuals, including people historically marginalized: Black and Latino individuals, older adults, and people with low income or serious illness. Objectives To understand if there are differences in communication-related healthcare experiences between people with and without serious illness. Methods We conducted a quantitative survey 4-5/2021 of a nationally representative sample of US adults, assessing participant communication experiences as outcomes. The primary predictor was having serious illness (yes/no). Self-reported covariables were age, gender, race/ethnicity, income, living in a metropolitan area, US region, and marital status. We conducted chi-square tests and multivariable logistic regression models adjusted for covariables to assess associations between serious illness and communication outcomes. Results We engaged 1,854 survey participants, 19% of whom had serious illness. People with serious illness were more likely than those without serious illness to report leaving a healthcare visit feeling unsure- 18.8% serious illness vs. 8.8% no serious illness (aOR 2.33 [95% CI 1.64-3.30]); more likely to report being afraid to ask questions, speak up, or disagree- 20.5% serious illness vs. 10.5% no serious illness (aOR 2.21 [95% CI 1.57-3.11]); and to report feeling talked down to or made to feel inferior- 12.5% serious illness vs. 8.7% no serious illness (aOR 1.89 [95% CI 1.24-2.90]). Conclusions These findings show that people with serious illness experience inequities in healthcare experiences and highlight the importance of empathetic communication in high-quality care. Recognizing these inequities is a critical step in improving quality of care for people with serious illness. Keywords Communication / Patient Outcomes