Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication.
Mohsen Bazargan, Sharon Cobb, Shervin Assari and 1 others
PMID 34476995WHAT IT FOUND
Adults with chronic illness who felt discriminated against because of income or insurance, or did not trust providers, were less likely to feel ready for worsening.
Ask about trust and discrimination before assuming race explains preparedness.
Key findings
01In adjusted analysis, perceived discrimination due to income, type of insurance, or lack of coverage was associated with lower serious illness preparedness, with an odds ratio of 1.652 for not being prepared (95% CI 1.299-2.101, p < 0.0001).
02Participants who did not trust their health care providers were less likely to report serious illness preparedness (OR 0.379; 95% CI 0.176-0.816; P < .02).
03In descriptive results, 34% of Hispanic participants, 24% of non-Hispanic Black participants, and 19% of non-Hispanic White participants reported not being prepared if their chronic condition worsened. After adjustment, race and ethnicity were not significant.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
The study was cross-sectional, so it can show associations but cannot prove that mistrust, discrimination, or poor communication caused lower preparedness. It used existing survey data, so the authors could not add questions that might better explain serious illness preparedness. All key variables were self-reported, so recall and social desirability bias are possible. Preparedness was measured with a single self-rated question, which may not capture what patients actually need. The sample was California adults with at least one chronic condition, and non-Hispanic Black participants were oversampled with non-probability methods, so generalizability is limited.
Declared interests
The authors declared no potential conflicts of interest. The survey data were collected on behalf of the California Health Care Foundation.
The easy way to misread this
Do not conclude that Black or Hispanic patients are less prepared simply because of their race. In the adjusted model, race and ethnicity were no longer significant, and the study cannot show cause because it was cross-sectional.