PM2075: Building Trust and Partnership with Black Children & Their Families to Promote Health Equity: Presence 5 for Racial Justice in Pediatrics Systematic Review

Background: Black children and their families face disparities in care due to clinician bias, exposure to racism (i.e., discrimination, stigma, historical trauma), and structural inequities. These have been shown to not only influence the likelihood of Black children experiencing other adverse childhood experiences, but also have detrimental effects on the child’s health (Lanier 2020). We sought to adapt a novel framework for anti-racism in medicine, Presence 5 for Racial Justice (P5RJ)– developed using multiple qualitative data inputs– by further integrating pediatric care specifics through a systematic literature review.

Methods: We conducted a PubMed search to identify strategies for clinicians and institutions to promote health equity for Black children and their families/caregivers. To determine inclusion, articles were screened through three rounds: 1) title, 2) abstract, and 3) full text. The following information was extracted from the accepted articles: population demographics; clinical setting, health disparities impacting Black children, and clinician or institutional strategies for promoting health equity in the care of Black children. We mapped the clinician strategies to the P5RJ domains. Through small-group meetings and workshops, we word-smithed practices, resolved disagreements in framework categorization, consolidated practices with overlapping concepts, and incorporated input from pediatric clinicians.

Results: In the final data extraction, n=52 articles were included. The resulting strategies were synthesized into the P5RJ in Pediatrics practices: 1) Prepare with Intention (i.e., Prepare to support children and their families/caregivers in retaining health knowledge and promoting behavior change by being aware of the barriers they may face in seeking/accessing care); 2) Listen Intently and Completely (i.e., Acknowledging that your patient and their family/caregiver have unique preferences around information-giving from clinicians, initiate a dialogue, while ensuring interest and comfort); 3) Agree on What Matters Most (i.e., Provide patient-centered and family-centered care by partnering with them as integral members of the care team, grounding care in their preferences and values, and exploring experiences); 4) Connect with the Patient’s Story (i.e., Work with each family to identify, acknowledge, and celebrate the facilitators that impact the child’s health, which may include family and community support, educational empowerment, and cultural care beliefs); and 5) Explore Emotional Cues (i.e., Take the time to inquire and acknowledge your patient’s experiences with other clinicians).

Conclusion: While not an all-encompassing guide for antiracism in medicine, this pediatric adaptation of P5RJ framework may be useful tool to promote racial justice for Black pediatric patients and their caregivers by recommending clinician communication practices that address anti-Black racism, build trusting relationships, and empower Black families in clinical care. The practices resulting from this literature review will be assessed in a future applied evaluation with clinicians working in pediatric patient populations.