The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses.

AIMS: To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses. DESIGN: Cross-sectional descriptive design. METHODS: Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis. RESULTS: Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence. CONCLUSIONS: The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical-focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses. REPORTING METHOD: We have adhered to STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.

The evolution of autonomy from two cooperative specialists in fluctuating environments.

From microbes to humans, organisms perform numerous tasks for their survival, including food acquisition, migration, and reproduction. A complex biological task can be performed by either an autonomous organism or by cooperation among several specialized organisms. However, it remains unclear how autonomy and cooperation evolutionarily switch. Specifically, it remains unclear whether and how cooperative specialists can repair deleted genes through direct genetic exchange, thereby regaining metabolic autonomy. Here, we address this question by experimentally evolving a mutualistic microbial consortium composed of two specialists that cooperatively degrade naphthalene. We observed that autonomous genotypes capable of performing the entire naphthalene degradation pathway evolved from two cooperative specialists and dominated the community. This evolutionary transition was driven by the horizontal gene transfer (HGT) between the two specialists. However, this evolution was exclusively observed in the fluctuating environment alternately supplied with naphthalene and pyruvate, where mutualism and competition between the two specialists alternated. The naphthalene-supplied environment exerted selective pressure that favors the expansion of autonomous genotypes. The pyruvate-supplied environment promoted the coexistence and cell density of the cooperative specialists, thereby increasing the likelihood of HGT. Using a mathematical model, we quantitatively demonstrate that environmental fluctuations facilitate the evolution of autonomy through HGT when the relative growth rate and carrying capacity of the cooperative specialists allow enhanced coexistence and higher cell density in the competitive environment. Together, our results demonstrate that cooperative specialists can repair deleted genes through a direct genetic exchange under specific conditions, thereby regaining metabolic autonomy.

Public management approaches to an aging workforce: organizational strategies for strategies for adaptability and efficiency.

This study investigates the impact of psychological age climate on the motivation of aged workers in China and explores the mediating mechanisms at play. Two proposed chains of mediation capture the potential mechanisms underlying this process. The first chain involves the task and knowledge characteristics of work design, specifically autonomy arrangements and skill-based job demands, as mediators. The second chain focuses on the social and physical/contextual aspects of work design, including social support and ergonomic working conditions. The study sample consisted of 1,094 Chinese employees aged between 50 and 70 years (M = 55.66, SD = 4.274). Our findings reveal that a positive psychological age climate-organizational norms and practices that value and support older workers-significantly boosts their motivation to continue working. This enhancement in motivation is mediated by increased job autonomy and robust social support within the workplace, confirming that these elements are crucial for translating a positive age climate into tangible outcomes. Contrary to existing literature, our research does not support the mediating role of job design tailored to aged workers' skills and ergonomic working conditions. This indicates that in the cultural and organizational context of China, where collective values and respect for elder wisdom predominate, autonomy and social support directly influence workers' motivation more profoundly than ergonomic and job design considerations. The study underscores the importance of creating inclusive organizational cultures and implementing targeted support strategies to retain and engage aged workers effectively. It suggests that public policymakers and organizational leaders should focus on fostering positive psychological age climates and providing necessary autonomy and social resources to meet the unique needs of an aging workforce, thereby enhancing both individual and organizational outcomes in a globally aging society.

Development of the Chinese coaches' autonomy-supportive-laissez-faire coaching style scale.

Introduction: The autonomy-supportive coaching style is recognized for its positive impact on athletes' well-being and performance. However, the transition of excessive autonomy into a laissez-faire coaching style has not been thoroughly examined within the context of coach evaluation scales. Existing scales focus predominantly on the positive dimensions of autonomy support, and do not possess the capabilities to measure outcomes which may be viewed as negative or other outcomes. This study aims to integrate the autonomy-supportive and laissez-faire coaching styles within the same measurement framework. Methods: Our study developed a comprehensive scale to assess both the autonomy-supportive and laissez-faire coaching styles, drawing on items from the Sport Climate Questionnaire for autonomy support and adapting items from leadership research for laissez-faire coaching. We conducted two studies: the first with 148 athletes to refine the laissez-faire items and the second with 460 athletes to validate the full scale, utilizing exploratory factor analysis, confirmatory factor analysis, and correlation analysis. We also measured internal consistency and split-half reliability. Results: The finalized scale includes a 6-item autonomy-supportive subscale and a 5-item laissez-faire subscale. Validation processes confirmed the scale's construct and criterion validity, alongside its reliability. Discussion: The Chinese Coaches' Autonomy-Supportive-Laissez-Faire Coaching Style Scale effectively captures both the beneficial and potentially detrimental aspects of coaching styles, addressing a critical gap in the literature and providing a reliable tool for evaluating coaching approaches.

Automated task-level autonomy assessment in robotic surgery.

INTRODUCTION: Surgical autonomy for trainees has remained elusive to quantify. Proportion of active control time (ACT) of a trainee during a robotic case can be used as a broad measure of autonomy. However, this metric lacks in the granular detail of quantifying at what specific steps trainees were actively participating. We aim to quantify trainee involvement during robotic-assisted hiatal hernia repair at a task-specific level. METHODS: We performed a retrospective review of surgical performance data from robotic-assisted hiatal hernia repairs performed. These cases were segmented into 5 tasks by AI-assisted annotation with human review. The segmented tasks included: hiatal dissection, gastric fundus mobilization, mediastinal dissection, cruroplasty and fundoplication. Tasks were excluded if video segmentation of tasks was incorrect. During each task, ACT was recorded for resident, fellow and attending. Resident and fellow ACT per task was compared using the Mann-Whitney U test. RESULTS: Residents had the highest %ACT in the hiatal dissection (53%), gastric fundus mobilization (84%) and fundoplication (57%) tasks. Fellows had greater than 80% ACT in all 5 tasks, with the highest %ACT in the gastric fundus mobilization (100%) and hiatal dissection (88%). There was a significant difference between resident and fellow ACT during mediastinal dissection and cruroplasty. CONCLUSIONS: This study demonstrates how objective performance metrics and automated case segmentation can quantify trainee participation at a task-specific level. By utilizing data afforded by a robotic surgery platform, we are able to provide an objective and automated form of assessment with minimal impact on the workflow of attendings and residents. Our findings can serve to inform residents on what steps they can expect to be involved in during the procedure, appropriate to their PGY level. With this task-level data, we can provide a roadmap for trainee progression to achieve full surgical autonomy.

Associations between parents' autonomy supportive management language and children's science, technology, engineering, and mathematics talk during and after tinkering at home.

We conducted a time series analysis of parents' autonomy supportive and directive language and parents' and children's STEM (science, technology, engineering, and mathematics) talk during and after a problem-solving activity (i.e., tinkering). Parent and child dyads (N = 61 children; Mage = 8.10 years; 31 boys; 54% White) were observed at home via Zoom. After tinkering, a researcher elicited children's reflections, and approximately 2 weeks later dyads reminisced together about the experience. During tinkering, the more autonomy supportive STEM talk parents used in 1 min, the more children talked about STEM in the next minute. During reminiscing, parents' autonomy support was also associated with children's STEM talk. Results suggest the importance of considering how both the content and style of parents' talk can support children's STEM engagement.

The effects of psychological capital, work engagement and job autonomy on job performance in platform flexible employees.

The performance of platform flexible employees is a core element that contributes to the rapid growth of the sharing economy platform. It is crucial to explore strategies to improve employees' performance with the growing competition among these platforms. Only a handful of research evidence has been found evaluating platform flexible employees' psychological capital and work engagement to improve their performance. In order to remedy the gap, we draw on self-determination theory to develop a moderated mediation model, which examines how psychological capital affects platform flexible employees' job performance. We employed hierarchical regression analysis to test the theoretical model and carried out two rounds of surveys, resulting in 474 valid paired questionnaires. The questionnaire assessed the psychological capital, work engagement, job performance, and job autonomy of flexible platform employees. The results indicate that work engagement plays a mediating role between psychological capital affects platform flexible employees' job performance. Moreover, job autonomy moderates the mediating effect. The findings not only contribute to the literature on employees' psychological capital and job performance, but also broaden the research scope of self-determination theory, and provide new ideas for improving the job performance of platform flexible employees.

Achieving Enteral Autonomy in Children with Intestinal Failure Following Inpatient Admission: A Case Series.

We describe cases of intestinal failure wherein inpatient admission was critical toward enteral autonomy. We performed a retrospective chart review of 6 children with long-term parenteral nutrition dependence who were weaned from parenteral nutrition following admission. Admissions included feeding and medication titration, interdisciplinary care, and home parenteral nutrition team consultation.

Patient autonomy and shared decision-making in the context of clinical trial participation.

AIMS: This study aimed to explore how incorporating shared decision-making (SDM) can address recruitment challenges in clinical trials. Specifically, it examines how SDM can align the trial process with patient preferences, enhance patient autonomy and increase active patient participation. Additionally, it identifies potential conflicts between SDM and certain clinical trial aspects, such as randomization or blinding, and proposes solutions to mitigate these issues. MATERIALS AND METHODS: We conducted a comprehensive review of existing literature on patient recruitment challenges in clinical trials and the role of SDM in addressing these challenges. We analysed case studies and trial reports to identify common obstacles and assess the effectiveness of SDM in improving patient accrual. Additionally, we evaluated three proposed solutions: adequate trial design, communication skill training and patient decision aids. RESULTS: Our review indicates that incorporating SDM can significantly enhance patient recruitment by promoting patient autonomy and engagement. SDM encourages physicians to adopt a more open and informative approach, which aligns the trial process with patient preferences and reduces psychological barriers such as fear and mental stress. However, implementing SDM can conflict with elements such as randomization and blinding, potentially complicating trial design and execution. DISCUSSION: The desire for patient autonomy and active engagement through SDM may clash with traditional clinical trial methodologies. To address these conflicts, we propose three solutions: redesigning trials to better accommodate SDM principles, providing communication skill training for physicians and developing patient decision aids. By focussing on patient wishes and emotions, these solutions can integrate SDM into clinical trials effectively. CONCLUSION: Shared decision-making provides a framework that can promote patient recruitment and trial participation by enhancing patient autonomy and engagement. With proper implementation of trial design modifications, communication skill training and patient decision aids, SDM can support rather than hinder clinical trial execution, ultimately contributing to the advancement of evidence-based medicine.

Patient-Centered Care in Action: How Clinicians Respond to Patient Dissatisfaction with Contraceptive Side Effects.

Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.

Patient-centered care in diabetes care-concepts, relationships and practice.

We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.

Non-Maleficence toward Young Kidney Donors: A Call for Stronger Ethical Standards and Associated Factors in Multidisciplinary Nephrology Teams.

BACKGROUND: The rising frequency of live kidney donations is accompanied by growing ethical concerns as to donor autonomy, the comprehensiveness of disclosure, and donors' understanding of long-term consequences. AIM: To explore donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding disclosure of donation consequences to live kidney donors. METHODS: A cross-sectional study was performed among Israeli live kidney donors who had donated a kidney in two hospitals that belonged to the Ministry of Health's Transplantation Center one year after the donation, from December 2018 to December 2020. Data collection was conducted online and through face-to-face interviews with the donors in their native language (Hebrew or Arabic). RESULTS: Overall, 91 live kidney donors aged 18-49 years were enrolled. Of those, 65.9% were males, and 54.9% were academic donors. Among the live kidney donors, 59.3% reported that the motivation behind the donation was a first-degree family member vs. 35.2% altruistic and 5.5% commercial. Only 13.2% reported that the provided disclosure adequately explained the possible consequences of living with a single kidney. Approximately 20% of the participants reported that the disclosure included information regarding their risk of developing ESRD, hypertension, and proteinuria. The donors reported a low mean of the index score that indicates a low follow-up by the physician after the donation (mean = 1.16, SD = 0.37). The mean GFR level was significantly lower in the post-donation period one year following a kidney donation (117.8 mL/min/1.73 m2) compared with the pre-donation period (84.0 mL/min/1.73 m2), p < 0.001. CONCLUSION: Our findings display that donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding the disclosure of donation consequences to live kidney donors is low. This study indicates that donors are at an increased risk of worsening kidney functions (creatinine and GFR), and BMI. Our findings underscore the imperative to advise donors that their condition may worsen over time and can result in complications; thus, they should be monitored during short and long-term follow-up periods. This study was not registered.

Influence of teacher autonomy support in feedback on high school students' feedback literacy: the multiple mediating effects of basic psychological needs and intrinsic motivation.

This research presents and confirms an intermediary model, deeply anchored in self-determination theory, to dissect the influence of Chinese high school students' core psychological needs and intrinsic drive on the nexus between educators' autonomous backing and students' proficiency in feedback literacy, highlighting the mediating roles of these elements. A survey of 704 Chinese senior high school students, including 319 males and 385 females, employed the Feedback Literacy Scale, Basic Psychological Needs Scale, Intrinsic Motivation Scale, and Perceived Teacher Autonomy Support Scale. The study's discoveries illuminate that educators' autonomous support not only directly amplifies students' feedback literacy but also has an indirect impact through the intermediation of basic psychological needs and intrinsic motivation, along with their interconnected dynamics. This inquiry not only deepens our grasp of the mechanisms interlinking teacher support with feedback literacy but also critically evaluates the findings to proffer targeted recommendations, thereby enhancing our comprehension of the underlying processes and guiding educational practices and student development.

The Influence of Institutional Logics and Emotions on the Uptake of Cervical Cancer Screening: A Case Study From Xai-Xai, Mozambique.

This study investigates the role of emotional attachment to competing institutional logics on women's uptake of cervical cancer screening in Mozambique. Through a qualitative study conducted in Xai-Xai, Southern Mozambique, we identify 2 concurrent logics in the context of screening: preservation logic, influenced by social-cultural norms, and the prevention logic, centered around screening. Women, affected by emotions such as shame, fear, and marital subordination, often become attached to the preservation logic, which influences their values and contradicts acceptance of screening. However, some women with marital autonomy may reflect on both logics and gradually detach themselves from the preservation norms and show their intention to adopt life-saving behavior by accepting screening. It is through their emotions that women show their attachment to and detachment from competing logics, reinforcing traditional norms on the one hand, or giving them the means to adopt preventive measures on the other. The study indicates that cultural expectations, shame and the desire to preserve intimacy tie women to the logic of preservation and have a negative impact on participation in cervical cancer screening. Consequently, to improve screening uptake in Mozambique, the authorities need to adapt screening to socio-cultural and emotional factors, empower women, and effectively engage communities.

The relationship between transformational leadership and teacher autonomy: A latent moderation analysis.

In Chinese kindergartens under a collectivist culture, leadership has a profound and complex impact on both the organization and teacher autonomy. This study explores the link between transformational leadership and teacher autonomy and the roles played by organizational climate and teacher empowerment in this relationship. Kindergartens teachers (n = 1593) were randomly selected in China to complete the transformational leadership scale, teacher autonomy scale, teacher empowerment scale and organizational climate scale, with a cross-sectional design and moderated mediation model using latent variables. The results were as follows: (1) transformational leadership can predict the level of teacher autonomy; (2) organizational climate plays a part of mediating role between transformational leadership and teacher autonomy; (3) as levels of teacher empowerment increase, the positive association between transformational leadership and organizational climate becomes stronger, while the positive association between organizational climate on teacher autonomy weakens.

Navigating autonomy: unraveling the dual influence of job autonomy on workplace well-being in the gig economy.

Introduction: With the rapid rise of the gig economy globally, its characteristics of promoting employment and facilitating autonomy have supported its rapid growth and development in China. While the flexibility of gig work offers more employment options and income sources for workers, it also caused many problems and uncertainties. Workplace well-being is an important psychological factor that indicates the psychological state of workers and significantly predicts their behavior at work. However, previous studies on the gig economy rarely analyze gig workers' workplace well-being, which is of great significance to improving their individual emotions, promoting their physical and mental health, and maintaining the sustainable development of the gig economy and society in general. Methods: This study draws on the cognitive-affective processing system framework to construct a moderated dual-mediator model to explore the dual influence mechanism of job autonomy on gig workers' workplace well-being. Based on the data of 442 digital gig workers who were mainly engaged in manual labor. Results: The survey results show that job autonomy positively affects employees' workplace well-being, and work alienation and positive emotion mediate this relationship. Perceived algorithmic control can moderate not only the influence of job autonomy on work alienation and positive emotion but also the indirect impact of job autonomy on workplace well-being through work alienation and positive emotion. Discussion: The finding of this research contributes to expand the comprehension of the relationship between gig-worker job autonomy and workplace wellbeing and this relationship's underlying mechanism, holding significant implications for management practice.

Workplace Causality Orientations Moderate Impostorism and Burnout: New Insights for Wellness Interventions in Graduate Medical Education.

Theory: Impostor phenomenon (IP) is strongly linked to physician burnout, but the nature of this association is not well understood. A better grasp of the mechanism between these constructs could shed new light on ways to mitigate physician IP and burnout. Grounded in self-determination theory (SDT), the present study explores whether and how residents' general causality orientations at work-impersonal, controlled, and autonomous-each moderate the effect of IP on physician burnout. Hypotheses: We theorized that the autonomous orientation would buffer the facilitative effect of IP on burnout, while the controlled and impersonal orientations would each enhance it to varying degrees. Method: Two hundred forty-three residents from the Universities of Saskatchewan, Calgary, and Alberta, across various programs, specialties, and years of training, completed a survey containing demographic questions and three previously validated instruments: the Clance Impostor Phenomenon Scale, Causality Orientations at Work Scale, and Oldenburg Burnout Inventory. We used partial correlation analyses to test our moderation hypotheses. Results: In line with what we expected, the autonomous causality orientation buffered the facilitative effect of IP on burnout, while the controlled and impersonal causality orientations each enhanced it. Conclusions: Results suggest that possessing a stronger autonomous causality orientation (and creating learning/work environments that prime it) will dampen the effect of IP on burnout, while possessing a stronger controlled or impersonal causality orientation (and creating learning/work environments that prime them) will each augment it. Findings and their implications are discussed in terms of instigating theory-informed, system-level wellness interventions in graduate medical education.

"Opportunities and responsibilities": how do pharmacists assess their professionalism?

INTRODUCTION: Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists. METHODS: To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups. RESULTS: 600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism. CONCLUSIONS: The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.

Differences in coaching in single- versus dual-console robotic cases: a mixed-methods study.

BACKGROUND: A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes. We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot. METHODS: Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework. RESULTS: Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments). CONCLUSIONS: Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery.

Reducing Racial Disparities at End-of-life: Using Narratives to Build Trust and Promote advance Care Planning.

Black Americans are less likely than White Americans to have advance directives, die while receiving hospice services, or have their end-of life wishes honored. The root causes of disparities include imbalance of resources, lack of trust in health care institutions, lack of adequate education regarding end-of-life options, communication differences of health care providers with black vs white patients, variable access to hospice services in different communities, and poorer pain management for Black patients compared to White patients. Because root causes are numerous, comprehensive solutions are required. When advance care planning is in place, people are more likely to choose care focused on priorities and comfort than on seeking aggressive, sometimes futile, interventions in the last weeks of life. One important component of the solution should include listening to narrative stories of Black people as they encounter life-limiting diagnoses. Gathering the stories about life events and how strength was found through adversities can be a tool for growing trusting relationships and engaging in shared decision-making. Health care professionals should invite Black patients with serious illnesses to explore the sources of their strengths and identify their core values to work toward developing directives for the nature and place of their end-of-life and help to mitigate disparities in high quality end-of-life care.