An Exploratory Qualitative Analysis of Explanations for COVID-19-Related Racial Disparities Among St. Louis Residents: "I Don't Really Pay Attention to the Racial Stuff Very Much".

Introduction: Public health explanations for the disproportionate share of COVID-19-related illness and death among the Black population often differ from lay explanations, which can affect the public's support for policies that address these disparities. This qualitative exploratory study examined the explanatory frameworks for COVID-19-related racial disparities in St. Louis among 54 St. Louis residents. Methods: From August 16, 2021, through May 20, 2022, we conducted semistructured interviews among a convenience sample of 54 St. Louis residents about their experiences during the COVID-19 pandemic. Directed content analysis identified participants' explanatory frameworks for racial disparities in COVID-19-related illness and death. We disaggregated coded excerpts by race, age, education, and income to examine emerging themes. Results: Lay explanatory frameworks for racial disparities in COVID-19 included vaccine mistrust, lack of personal responsibility, low perceived susceptibility to COVID-19, pre-existing conditions or genetic predisposition, institutional racism, barriers to care, low socioeconomic status, insufficient information on COVID-19, and the inability to work remotely. Black interview participants addressed issues of systemic racism, inequitable allocation of COVID-19 vaccines, and institutional mistrust, whereas White participants did not directly acknowledge the role of racism. Both Black and White participants identified lack of personal responsibility among young Black people as a source of these disparities. Conclusion: This work identifies a need for improved health communication about racial disparities in COVID-19-related illness and death. Messaging that highlights racism may be less effective among the White population than the Black population in the US, whereas narratives that include the theme of individual choice may appeal broadly. Further research is needed on the use of communication strategies based on lay individuals' explanatory frameworks for COVID-19-related racial disparities to enhance support for equitable public policy.

Trusted sources for COVID-19 testing and vaccination: lessons for future health communication.

BACKGROUND: Promoting COVID-19 vaccination (both the primary series and boosters) remains a priority among healthcare professionals and requires understanding the various sources people trust for acquiring COVID-19 information. METHOD: From October 2021 to May 2022, we interviewed 150 people who called 2-1-1 helplines in Connecticut and North Carolina about their COVID-19 testing and vaccination experiences in order to (1) better understand where people obtain trusted COVID-19 health information and (2) identify how public health professionals can share emergency health information in the future. We used a mixed methods approach in which semi-structured qualitative interviews and survey data were collected in parallel and analyzed separately. RESULTS: Participants were mostly female (74.0%), Black (43.3%) or White (38.0%), and had a high school degree or higher (88.0%). Most had prior COVID-19 testing experience (88.0%) and were vaccinated (82.7%). A variety of information sources were rated as being very trustworthy including medical professionals and social service organizations. We found that repetition of information from multiple sources increased trust; however, perceived inconsistencies in recommendations over time eroded trust in health communication, especially from government-affiliated information sources. Observations such as seeing long lines for COVID-19 testing or vaccination became internalized trusted information. CONCLUSIONS: Public health professionals can leverage the reach and strong community ties of existing, reputable non-government organizations, such as physician groups, schools, and pharmacies, to distribute COVID-19 information about vaccination and testing.

Cultivating the ideal obstetrical patient: How physicians-in-training describe pain associated with childbirth.

We explore the work labor pain does in cultivating obstetrics and gynecology (OB/GYN) resident physicians' conceptualization of the "ideal" obstetrical patient - replete with moral, pharmacological, classed, and racialized dimensions. Our data is derived from a single-site, qualitative study conducted at an urban academic OB/GYN residency program in the midwestern U.S. between 2018 and 2019. 36 residents, 9 from each post-graduate year, were randomly selected to complete a semi-structured interview on their perceptions of patient pain surrounding OB/GYN procedures. Grounded theory analysis of the OB/GYN residents' interviews revealed the idealized obstetrical patient is quiet and easily controlled. Residents praised women whom they believed were suppressing their labor pain, a racialized and classed concept that furthers misconceptions about the "obstetric hardiness" of Black women and the hypersensitivity of wealthy White women. Participants' conceptions of "bad" patients included those with less cultural health capital due to low health literacy and socioeconomic status, which impeded the patients' ability to participate in shared decision-making. Despite acknowledging the importance of patient autonomy regarding pain control during labor, the interviewed residents positioned themselves as the ultimate authority. Their subjective assessment of patients' pain inherently invoked their personal biases, such as conflating low socioeconomic status and race. Some participants posited an inverse relationship between hardship and pain, while others questioned whether those with low health literacy exaggerate their pain due to fear of the clinical encounter or to secure medical attention. Both framings have concerning implications for inadequate pain control and the unintentional perpetuation of obstetric violence and obstetric racism within the profession.

Questioning Biomedicine's Privileging of Disease and Measurability.

Within biomedicine, the diagnosis of disease is often privileged over a patient's experience of illness. Yet up to 30% of primary care visits might be attributable to persistent illness without a diagnosed disease, including functional somatic syndromes like fibromyalgia and chronic fatigue syndrome. When clinicians are unable to diagnose disease or correlate symptoms with measurable changes in biomarkers, patients experiencing such an illness are at increased risk for suspicion, misplaced questioning, or having their motives misinterpreted through damaging social and cultural narratives about gender, race, ethnicity, socioeconomic status, or disability. Adhering strictly to a biomedical model of thinking about disease and diagnosis can prevent clinicians from empathically engaging with patients and helping them navigate their illness experiences.

Mitigating ethical conflict and moral distress in the care of patients on ECMO: impact of an automatic ethics consultation protocol.

AIMS: This study evaluates a protocol for early, routine ethics consultation (EC) for patients on extracorporeal membrane oxygenation (ECMO) to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress. METHODS: We conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019 (n=68). Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers' perceptions of the impact of the early intervention protocol. RESULTS: Limited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a 'bridge to nowhere', EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy. CONCLUSION: Data from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC-at least while this medical technology is in its nascent stages.