When We Label Goals of Care as “Aggressive”: Moving Away from Unintended Harms Towards Respecting Faith, Hope and Miracles in African American Christians at End-of-Life (TH122)

Outcomes 1. Identify communication pitfalls that can arise from labeling some forms of care as “aggressive” 2. Examine the way the term “aggressive care” has evolved to uphold institutional racism in end-of-life care 3. Recognize the role of faith in end-of-life decision making for African American Christians “Aggressive care” is a value-laden term with multiple applications in the medical literature. For patients with terminal illness, the literature describes aggressive care as decreasing quality of life, increasing economic burden, and reducing the likelihood of experiencing a “good death.” African Americans are more likely to request interventions that are labeled “aggressive,” including feeding tubes, mechanical ventilation, and cardiopulmonary resuscitation. African Americans are more religious than the broader U.S. population on a variety of measures. In the absence of consistently available, trustworthy medical care for many generations, African American Christians learned to depend on God's miraculous healing power. The term “aggressive” is used more often in end-of-life care of African Americans, and it discounts, discredits, and dismisses the deeply held beliefs of Christian African Americans. This form of racism results in a higher proportion of African Americans than whites receiving care that is not goal concordant and contributes to the lack of trust the African American community has in our healthcare system. Because almost 80% of African Americans who face life-limiting circumstances rely heavily on their faith foundation, they frequently use religious dialogue with healthcare providers. We will begin this session with a role-play that demonstrates communication pitfalls that can arise from framing care as “aggressive.” We will then present the history of the term “aggressive care” and show how it contributes to institutional racism. We will move to an interactive panel discussion to illuminate the beliefs and experiences of African American Christians. We will conclude by revisiting the role-play to impart effective communication tools that clinicians can use in their practice. We will demonstrate how clinicians who exhibit a willingness to be fully present, are respectful, and acknowledge how faith will influence care choices and needs for the patient are capable of bridging a cultural divide.