Why Black, Hispanic, and Asian patients hesitate to opt for palliative care: Deep metaphors from patients, community leaders, and clinicians with shared cultural identities to shape more effective outreach

Why Black, Hispanic, and Asian patients hesitate to opt for palliative care: Deep metaphors from patients, community leaders, and clinicians with shared cultural identities to shape more effective outreach
Journal of Palliative Medicine; by Anthony L Back, MaryGrace S King, Kathy C Shaw, Kelly Willis, Malcolm Brooks, Arigun Bayaraa, Leon He, Vanessa Herman, Ivan Sanchez, Lindsay Zaltman, Marian S Grant; 9/25
In the United States, national data show that Black, Hispanic, and Asian patients are less likely than White patients to receive palliative care (PC) despite comparable or greater symptom burden. We enrolled 15 patients (5 Black, 5 Hispanic, 5 Asian), 8 community leaders (5 Black, 3 Hispanic, 1 Asian), and 6 palliative care clinicians (2 Black, 2 Hispanic, 2 Asian). Patients' images about their experiences of being offered PC revealed the metaphor of "inside/outside"-a sense of simultaneous inclusion and exclusion with regard to their community and also the medical system. The patients' sense of belonging and protection felt from their communities was demonstrated in images that evoked the metaphor of "home," as a physical and emotional place with a sense of belonging. The metaphor of home as a place of belonging was mirrored in community leader and PC clinician interviews.