Physician Perception of Trust and Communication with Asian Patients with Serious Illness and Their Families in the United States: An Exploratory Qualitative Study.

Background: Asians in the United States receive less palliative care and enter hospice less than Whites, disproportionately receive more invasive mechanical ventilation, and report less involvement in decision-making with physicians than they would like. Despite the growing literature addressing serious illness in diverse patient populations, communication with Asians is understudied. This study aimed to explore U.S. physician perceptions of clinical interactions with Asian patients with serious illness and barriers and facilitators to physician-patient communication. Methods: This is an exploratory qualitative descriptive study using semistructured interviews with U.S. physicians who cared for Asian patients with serious illness. We used an inductive content analysis approach to identify themes related to facilitators and barriers to communication between Asian patients, their families, and physicians. Results: We conducted 10 physician interviews between February and April 2024. Of participants, 50% were White and 50% were Asian, the majority were male, and 50% specialized in palliative care. Three major themes arose: (1) trust cannot be assumed; (2) understanding and honoring the role of family are key; and (3) honoring the patient's preferences for communication can build trust. Conclusion: This study is a step in illustrating how a cross-cultural approach to communication needs to align physicians, patients, and families on the process of communication and shared decision-making and not only on the goals for care. Moving toward a cultural adaptive approach can empower clinicians to engage in a trust-building process of inquiry, observation, and understanding of how sociocultural factors impact patient preferences for health care.