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London Metropolitan University
The healthcare experience for patients of minority ethnic heritage can be tainted by bias, with outcomes suffering. So what can we do to address that inequality?
The issues patients from minority ethic backgrounds experience when seeking healthcare – like lack of empathy, discrimination, and poor outcomes – are well documented.
Nursing Standard. 39, 1, 35-36. doi: 10.7748/ns.39.1.35.s18
Published: 03 January 2024
My colleagues and I set out to investigate the social influences on healthcare interventions, with a particular focus on psychological approaches, especially in cancer care.
The team, led by the University of Westminster and including Queen Mary University London, Oxford University the University of Portsmouth and Kings College London, featured individuals from a range of ethnic backgrounds, ensuring a broad perspective in the interpretation of the data. The study was funded by the National Institute for Health and Care Research.
‘It is the everyday human things that connect us and that are important to us, that have been overlooked in treatment of patients from minority ethnic backgrounds’
Our meta-ethnographic method – bringing together all relevant studies on a topic to see if a better understanding can be developed – uncovered a ‘hidden’ but emotionally vibrant world in healthcare consultations, a world that was easy for professionals to miss.
The study focus was patient perspectives, providing a rich understanding of the patient experience, while acknowledging the absence of professional perspectives on this issue. However, concentrating on patient perspectives allowed us to delve more deeply into the experience of individuals from minority ethnic backgrounds, shedding light on the unique challenges and needs they may have when accessing psychological interventions and cancer services.
We found patients essentially yearned to have, but less frequently achieved, professional recognition and valuing of their life circumstances in the round. Or, as one participant in one of the studies we examined said, professionals ‘who will listen to us, who will allow us to talk’.
Essentially, we found it is the everyday human things that connect us and that are important to us, that have been overlooked in the treatment of patients from minority ethnic backgrounds.
If this was better understood by professionals, it could help to improve care – otherwise, patients risk becoming distanced and even alienated from their healthcare.
Warmth shown by professionals was especially longed for. For example, one participant in an included study said of her practitioner: ‘Even though she is a white person, I know that she sympathises with me… When I am uncomfortable, you can tell that she feels my pain…’.
Interestingly, the language of affection and connection was used to describe successful partnerships with professionals. An asylum seeker from Sudan in a UK study said: ‘If she has not won my love, some of the things, it’s not easy to talk about it…[but she’s shown me] she’s concerned with my life.’ Others talked about valued and skilled practitioners as being like a member of their family.
Many participants in the studies reviewed turned to their relationship with a higher power, or to their families, for the sense of comfort they longed for. This could be especially the case if healthcare was not seen as a safe place, which was frequently the case.
We found that religion could be, in the words of one included study, a ‘force which sustained’ patients in their struggles and ‘hard lives’, while health decisions could be made by families, rather than individuals. For example, in another study, a participant noted how ‘we make decisions as a family’.
1. Assume patients are already ‘weathered’ by racism Your patient has probably experienced subtle and not so subtle forms of discrimination and racism in healthcare and/or more widely in society. So, they might lack trust and be disengaged. What is the one thing you can do that says you value your patient just as they are?
2. Challenge systemic racism in your own practice The prioritisation of European knowledge and ways of doing things is thought to be embedded in our ways of thinking, theories, practices, regulations and laws. Are you at least willing to negotiate with patient concerns and beliefs if they depart from western medical orthodoxy?
3. Be open in your approach For example, be curious about differences, and be inclusive of them. Can you find ways to connect with patients as whole people – people with lives, worries and loved ones who care about them?
4. Recognise that support comes from many sources Patients are likely to get support from a whole range of sources, including their families, religious institutions, spirituality, alternative medicine, and/or communities
5. Communicate warmth If nothing else, appreciate that all patients want to be treated as a whole person, and with warmth. Recognise the ways you show people you have seen them and accept them. How do you communicate this kind of friendliness? Who knows, you could be the one to transform a patient’s experience
In summary, our study uncovered a whole world of emotional issues that played out largely behind the scenes in healthcare interventions and that professionals were frequently thought to overlook, for example, the potential for facing stigma, issues of safety, fear of rejection; and connection, for example love, affection, hope.
While different patients will want different approaches, the importance of warmth, empathy and acceptance in health consultations should be explored as a way of improving care for patients from minority ethnic backgrounds. Interestingly, this poses the question: why don’t health practitioners routinely offer this type of positivity to every patient? What gets in the way?
Patients, irrespective of their background, want to feel connected to their healthcare professionals. But discrimination adds more distance, meaning patients from minority ethnic groups can end up feeling less cared for than their white counterparts.
Our study underscores the importance of understanding the central role of making connections in care, suggesting a shift in focus from developing competencies related to a range of cultures, to a focus on fostering more meaningful connections with patients. Given that creating meaningful links is something we all strive for in life, presumably it is something that is easier to teach than cultural competence.
Further information
The study’s co-authors were: Karen Pilkington, Sheila Donovan, Elisavet Moschopoulou, Dipesh Gopal, Kamaldeep Bhui, Trudie Chalder, Imran Khan, Ania Korszun and Stephanie Taylor
