“God Is Able”: Miracles and Hope in Our African-American Patients: Challenges, Historical Perspective and the Way Forward (FR459)

Abstract

•Recognize potential pitfalls and missed opportunities in responding to family members’ communication about their belief that God will perform a miracle and heal their loved one despite medical team’s belief that patient is at the end of life. Gain understanding of both sides of an interaction in which the clinician encounters a terminally ill African-American patient and family who are expecting a miracle; the clinician who feels frustrated and manipulated by the patient/family who are not facing the reality of impending death; the patient and family who feel their beliefs and culture are being entirely disregarded.•Describe the ongoing challenges and historical context which inform a belief in miracles and emphasis on hope for African Americans across the lifespan, including at the end of life. Gain insight into the concept of “hope and miracles” in the African-American community, from (1) A historical and cultural context and (2) In terms of how it plays out in serious illness.•Describe communication strategies which demonstrate respect, build trust, and reduce conflict in responding to family’s expression of a belief in miracles in the face of a patient’s poor prognosis. Gain insight into a communication method in which the patient and family’s values of hope and a miracle are respected by the clinician; and the resulting feelings of (a) the patient/family and (b) the clinician. End of life care in the U.S. has been rooted in values that represent the cultural and religious values of the white middle class. Yet what is perceived and promoted as beneficial for one group may not hold the same value for another groups, with a different frame of reference, value system and life experience. Lack of understanding of, and respect for, the cultural values of others often results in negative consequences for the patient and family. Patients and families whose beliefs and values are not understood or addressed, understandably feel disrespected and devalued, and have to make additional efforts to ensure that the goals of care they wish for themselves/ their loved ones, are followed. Palliative care clinicians often feel frustration when they see a terminally ill patient undergoing “needless” interventions/treatments. In the African-American community the importance of faith, spiritual beliefs and church are key components in understanding and coping with illness, and provide a framework within which treatment decisions are made. African-American families’ deep faith in God’s healing power, and the belief in hope, both of which directly impact goals of care and treatment preferences, are often misunderstood by clinicians. In this session, participants will gain an understanding into the central relevance of “hope and miracles” in the African-American community, from both a historical and cultural context, as well as how it plays out in serious illness. Illustrations will be provided of ineffective clinician-patient/family communication (resulting in the patient/family feeling disrespected and a frustrated clinical team), as well as positive communication. Take-home lessons for effective culturally-based communication and best practices are provided.