A 36-Year-Old Black Male With Sickle Cell Disease and Coexisting Psychiatric Comorbidity: Utilizing Open Dialogue Practices to Overcome Stigma and Enhance Patient-Centered Care.

Abstract

A 36-year-old African American male with sickle cell disease (SCD), osteomyelitis, major depressive disorder (MDD), and alcohol use disorder presented with active suicidal ideation following a suicide attempt via increasing alcohol consumption. Diagnostic evaluation suggested MDD. Within the hospitalization, he was also diagnosed with comorbid obsessive-compulsive disorder. Pharmacologic treatment was initiated with sertraline titrated to 150 mg daily, and his pain was managed with buprenorphine-naloxone 1 mg twice daily, meloxicam 15 mg daily, and acetaminophen 650 mg every 6 h as needed. He also engaged in individual and group psychotherapy, including interventions from psychology and occupational therapy teams, and completed a comprehensive safety plan. Early in the hospitalization, the patient began to share his experiences of mistrust in the healthcare system and stigma as a black patient with SCD. The approach of open dialogue (OD) was then introduced which consisted of providers openly sharing their assessments with the patient present and allowing the patient to provide reflections to further promote transparency and collaboration with patient care. Upon discharge, the patient shared positive feedback on this approach. The patient expressed appreciation for the transparency and collaborative nature of the discussions, which helped to build rapport and reduce mistrust in healthcare institutions. This case illustrates the potential for integrating OD principles to promote transparency and collaborative decision making that could help mitigate the detrimental effects of stigma and structural racism for black patients with SCD. Developing and testing standardized OD protocols could potentially further enhance patient-centered care and reduce healthcare disparities.