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Respecting Faith, Hope, and Miracles in African American Christian Patients at End-of-Life: Moving from Labeling Goals of Care as “Aggressive” to Providing Equitable Goal-Concordant Care

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Abstract

In this article, we demonstrate first how the term “aggressive care,” used loosely by clinicians to denote care that can negatively impact quality of life in serious illness, is often used to inappropriately label the preferences of African American patients, and discounts, discredits, and dismisses the deeply held beliefs of African American Christians. This form of biased communication results in a higher proportion of African Americans than whites receiving care that is non-goal-concordant and contributes to the prevailing lack of trust the African American community has in our healthcare system. Second, we invite clinicians and health care centers to make the perspectives of socially marginalized groups (in this case, African American Christians) the central axis around which we find solutions to this problem. Based on this, we provide insight and understanding to clinicians caring for seriously ill African American Christian patients by sharing their beliefs, origins, and substantive importance to the African American Christian community. Third, we provide recommendations to clinicians and healthcare systems that will result in African Americans, regardless of religious affiliation, receiving equitable levels of goal-concordant care if implemented.

Key Message

Labeling care at end-of-life as “aggressive” discounts the deeply held beliefs of African American Christians. By focusing on the perspectives of this group clinicians will understand the importance of respecting their religious values. The focus on providing equitable goal-concordant care is the goal.

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Funding

Dr. Gazaway receives funding from an unnumbered Dean Scholar Award supported by the University of Alabama at Birmingham School and Nursing and the Dr. Chuang receives funding from the National Institute of Minority Health and Health Disparities (K23MD015277). The authors declare that funders had no role in the development, review, or revision of this manuscript.

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Authors and Affiliations

  1. Department of Family, School of Nursing, University of Alabama Birmingham, Community, and Health Systems 1720 2nd Avenue South, AB, N485C,35294-1210, Birmingham, USA

    Shena Gazaway

  2. Albert Einstein College of Medicine, Bronx, NY, USA

    Elizabeth Chuang

  3. School of Medicine, UAB, Birmingham, AL, USA

    Moneka Thompson & Ronit Elk

  4. Harvard Divinity School, Boston, MA, USA

    Gloria White-Hammond

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  1. Shena Gazaway
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  4. Gloria White-Hammond
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All authors contributed to the conception, design, editing, and framing of this article. The first draft was written collectively, and all reviews, edits, and comments were done by group. All authors read and approved of the final manuscript.

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Correspondence to Shena Gazaway.

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Gazaway, S., Chuang, E., Thompson, M. et al. Respecting Faith, Hope, and Miracles in African American Christian Patients at End-of-Life: Moving from Labeling Goals of Care as “Aggressive” to Providing Equitable Goal-Concordant Care. J. Racial and Ethnic Health Disparities 10, 2054–2060 (2023). https://doi.org/10.1007/s40615-022-01385-5

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