African American Communities Speak to Palliative Care Clinicians: Evaluation of an Innovative Community-Developed Communication Skills Training Program (TH370D)

Abstract

•Recognize importance and relevance of culture to EoL.•Describe CBPR and focus group methods.•Describe appropriate training methods. Lack of understanding of cultural differences may significantly compromise care at end-of-life (EOL) for minority patients. Cultural competence among clinicians increases the likelihood of providing quality care, leads to higher patient satisfaction, and reduces health disparities. (1) Evaluate the feasibility of delivering a community-developed and theory-based training program focusing on the cultural aspects of EOL care in rural, Southern African Americans (SAA) to Palliative Care (PC) clinicians; (2) Assess the effect of this program on PC clinicians' knowledge of SAA cultural values towards EOL care and confidence in ability to change practice. The 3-hour training consists of: Overview of relevance of culture to EOL; debriefing of three videos developed by SAA pastors and healthcare professionals featuring key messages for communicating with and providing culturally appropriate care to SAAs with serious illness; a skills-based and reflective communication training program; and a discussion with an AA chaplain on the importance of faith and religious community among SAAs. Feasibility: Twenty-three of 30 UAB PC clinicians participated in the training. Adherence to training protocol was high. Knowledge: Clinicians' self-reported knowledge of SAAs attitude towards EOL care significantly increased on 9/18 measures (e.g., attitudes of being told prognosis; decision-making style; and family and community resources). Confidence: Clinicians scored 9 out of 12 items measuring confidence to chance practice [1 (least) to 5 (most)] as 4.0+ (e.g., asking how they wished to hear about prognosis; ensuring all those wanted are included in discussions). Only one item scored 3.4 or less. A community-developed and theory-based training program was feasible to administer and resulted in significant changes in multiple areas of clinician knowledge of SAA, and a high level of confidence in changing practice.