LAUSR

In response to decades of systemic racism, protests calling for equality are occurring across the United States. Black Americans want change. This is not surprising given so many Black Americans experience racial discrimination, including in healthcare encounters. 2 Unfortunately, the COVID-19 pandemic has both revealed and exacerbated racial inequalities in health. Deterred by discrimination, myriad barriers, and clinician biases, Black Americans have been less likely than Whites to be referred for coronavirus testing and are more likely to postpone seeking care until illness is so advanced it requires hospitalization, contributing to health disparities in COVID-19 outcomes. 6 Black Americans are dying from coronavirus at more than twice the rate of White Americans, with even greater disparities among persons of working age. Although Black Americans represent 13% of the population, they represent nearly 25% of COVID-related deaths. The age-adjusted COVID-19 death rate for Black Americans is 3.6 times that of Whites, underscoring evidence that social determinants are at the root of health disparities. 10, 11 Disparities in COVID mortality rates have been attributed to higher incidence of co-morbidities (e.g., heart disease, diabetes); socioeconomic factors such as population density, residential segregation, and a greater likelihood to work in service industry jobs that increase exposure to COVID-19; limited access to care; and clinician biases that affect how providers perceive and communicate with Black patients, possibly delaying coronavirus diagnosis and affecting treatment. 10– 13 Unfortunately, pandemics have historically amplified existing health inequities and disproportionately affected disadvantaged groups. In addition to enduring disparities in health outcomes, Black Americans experience poorer quality patient-clinician communication compared to Whites. 15 This difference is problematic given effective communication is a cornerstone of patient-centered care and preference-consistent outcomes. 17 Racism, discrimination, and feeling unheard in healthcare encounters contribute to racial disparities in health communication. 18, 19 Even when seriously ill, Black Americans are less likely than Whites to experience discussions with their healthcare providers about prognosis, personal goals, values, and end-of-life treatment preferences. In addition, lack of racial diversity resulting from relatively low numbers of Black clinicians can further contribute to poorer communication quality, information-giving, patient participation, and participatory shared decision-making for Black patients compared to Whites. 21 In this paper, we argue that engaging palliative care early in patient care may help close racial gaps in coronavirus outcomes and that incorporating goals-of-care communication tools and training across settings and specialties may improve outcome disparities among Black Americans with COVID-19. The pandemic has highlighted the importance of discussing care goals and providing goal-concordant care to vulnerable older adults and those with chronic or acute illnesses, including Black Americans at greater risk for poor COVID-19 outcomes. Discussing care goals is critical given the likelihood a COVID-19 vaccine may not be adopted by Black Americans as readily as members of other racial groups. Citing fear of safety and efficacy of the vaccine and concern that vaccine development is not taking the needs of Black Americans into account, 23 half of Black adults report they do not plan to take the vaccine once one becomes available—even if it is free and scientists declare it safe. Palliative care consultations involving discussions about patient goals and values, which are recommended by the National Institute of Health when caring for persons with COVID-19, may help mitigate racial disparities 25 associated with serious illnesses such as COVID-19. Researchers have found Black patients are as likely as White patients to engage in goals-of-care conversations when led by trained palliative care clinicians. 25 Primary palliative care and hospital-based palliative care teams trained in serious illness communication support patient decision-making by providing Received September 2, 2020 Accepted December 22, 2020