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Ethnocentrism, Racism, and the Misuse of Culture in US Medical Professional Organizations: The Case of Hospice and Palliative Care [Editorial]

Berger, Jeffrey T; Ribeiro Miller, Dana
PMID: 38503932
ISSN: 1525-1497
CID: 5640452

Clarity on Race, Racism, and Ethnocentrism in the Medical Literature [Letter]

Berger, Jeffrey T; Ribeiro Miller, Dana
PMID: 37352943
ISSN: 1873-6513
CID: 5543012

Physicians Should Stop Breaking Bad News [Editorial]

Berger, Jeffrey T; Ribeiro Miller, Dana
PMID: 35411537
ISSN: 1525-1497
CID: 5204322

I've Got the Power: Nurses' Moral Distress and Perceptions of Empowerment

DiGangi Condon, Kathleen A; Berger, Jeffrey T; Shurpin, Kathleen M
BACKGROUND:Nurses experience moral distress when they feel disempowered or impeded in taking the ethically right course of action. Research suggests an inverse relationship between moral distress and empowerment. In the intensive care unit, providing palliative care services may reduce moral distress because palliative care is often provided in situations that give rise to moral distress. OBJECTIVE:To evaluate the effect of nurses' use of a palliative care screening tool on their moral distress and perceptions of empowerment. METHODS:A pretest-posttest pilot study was conducted involving day-shift medical intensive care unit nurses. The nurses administered a palliative care screening tool to their assigned patients daily for 8 weeks and communicated the results to an attending physician or fellow. Demographic information was collected, along with data on nurses' moral distress and perceptions of structural and workplace empowerment before and after the intervention. Moral distress was evaluated using the Moral Distress Scale-Revised. Perceptions of structural and workplace empowerment were quantified using the Conditions for Work Effectiveness Questionnaire-II and the Global Empowerment Scale, respectively. RESULTS:Preintervention and postintervention surveys were completed by 17 nurses. Paired-sample t tests revealed a significant decrease in the frequency of moral distress (t16 = -2.22, P = .04) and a significant increase in workplace empowerment (t16 = -2.75, P = .01). No significant changes in moral distress intensity or structural empowerment were found. CONCLUSION:Nurses' sense of empowerment and the frequency of moral distress are favorably affected by active participation in assessing and communicating patients' palliative care needs.
PMID: 34719711
ISSN: 1937-710x
CID: 5037742

Health Disparities, Systemic Racism, and Failures of Cultural Competence

Berger, Jeffrey T; Miller, Dana Ribeiro
Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Instead, it has adopted a culture-based agenda through the framework of cultural competence to address disparities despite a paucity of supporting data. Cultural competence is ethnocentric in orientation and its content sustains biases that are long-standing in health care. Moreover, Cultural competence is based on a number of flawed assumptions and is not structured around a set of clearly stated ethical values. In this paper, we will demonstrate ways in which Cultural competence reflects embedded ethnocentrism, perpetuates entrenched biases, and fails to recognize the depth and breadth of systemic racism as these relate to the stated goal of Cultural competence-the mitigation of health disparities. In addition, we offer a reframed approach to health disparities in medical education.
PMID: 33955810
ISSN: 1536-0075
CID: 5265702

Ethics and Society: Physician Assisted Suicide and White Ethnocentrism [Letter]

Miller, Dana Ribeiro; Berger, Jeffrey T
PMID: 34077787
ISSN: 1873-6513
CID: 5265712

The Role of Medical Schools in Propagating Physician Bias [Comment]

Miller, Dana Ribeiro; Berger, Jeffrey T
PMID: 34133875
ISSN: 1533-4406
CID: 5265692

The Impact of COVID-19 Surge on Clinical Palliative Care: A Descriptive Study from a New York Hospital System

Moriyama, Derek; Scherer, Jennifer S; Sullivan, Ryan; Lowy, Joseph; Berger, Jeffrey T
CONTEXT/BACKGROUND:In spring 2020, New York experienced as surge of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (COVID-19) disease, as part of a global pandemic. There is limited data on populations of COVID-19 infected patients seen by palliative care services. OBJECTIVE:To describe a palliative care population at one New York hospital system during the initial pandemic surge. METHODS:This repeated cross sectional, observational study collected data on palliative care patients in a large health system seen during the COVID-19 outbreak and compared it to pre-COVID data. RESULTS:Palliative service volume surged from 678 (4% of total admissions) pre-COVID-19 to 1,071 (10% of total admissions) during the COVID-19 outbreak. During the outbreak, 695 (64.9%) of palliative patients tested positive for the virus. Compared with a pre-outbreak group, this COVID-19 positive group had higher rates of male (60.7% vs 48.6%, p < 0.01) and Latino (21.3% vs 13.3%; p < 0.01) patients and less white patients (21.3% vs 13.3%; p < 0.01). Our patient's with COVID-19 also had greater prevalence of obesity and diabetes and lower rates of end-stage organ disease and cancers. The COVID-19 positive group had a higher rate of intensive care unit admissions (58.9% vs 33.9%; p < 0.01) and in-hospital mortality rate (57.4% vs 13.1%; p < 0.01) compared to the pre-outbreak group. There was increased odds of mortality in palliative care patients who were COVID-19 positive (OR = 3.21; 95% CI = 2.43 - 4.24) and those admitted to the ICU (OR = 1.45; 95% CI = 1.11 - 1.9). CONCLUSION/CONCLUSIONS:During the initial surge of the COVID-19 pandemic in New York, palliative care services experienced a large surge of patients who tended to be healthier at baseline and more acutely ill at time of admission than pre-COVID palliative patients.
PMID: 33359217
ISSN: 1873-6513
CID: 4731312

Corona and Community: The Entrenchment of Structural Bias in Planning for Pandemic Preparedness [Comment]

Berger, Jeffrey T; Miller, Dana Ribeiro
PMID: 32716812
ISSN: 1536-0075
CID: 4546512

"Being Do Not Resuscitate" [Letter]

Berger, Jeffrey T; Miller, Dana Ribeiro
PMID: 32105546
ISSN: 1557-7740
CID: 4604892