Discovering What Matters for Urban FQHC Patients: Can the Letter Project Help?

Outcomes

1. Participants will be able to identify the barriers that prevent minoritized patients from having high-quality values-centered conversations with their provider.

2. Participants will be equipped with the tools and resources to pilot a letter-based approach to discussing “What Matters” with their patients.

Key Message

Studies have shown that racial minority and non-English speaking patients experience reduced frequency and quality of values-centered conversations. Barriers commonly faced by providers include time, comfort, and competing priorities. We hypothesize that using a letter-writing exercise to discuss “What Matters” may reduce these barriers at an urban federally qualified health center (FQHC) serving a diverse patient population.

Abstract

Studies have shown that both patients and providers find values-centered conversations to be important and meaningful to the therapeutic relationship. (1) Unfortunately, racial minority and non-English speaking patients experience reduced frequency and quality of such conversations. (2) Barriers that providers encounter when attempting to have these conversations include time, comfort, and competing priorities in safety-net clinical settings. (3-5)

Objectives

Our objectives are to (a) implement a letter-based approach, adapted from the Stanford Letter Project (6), to discuss "What Matters" with patients in a high-volume, safety-net primary care setting and (b) investigate patient and provider experiences with this exercise to understand the feasibility of this approach to improving the frequency of values-centered conversations.

Methods

10 provider/patient pairs from an urban FQHC serving primarily racial minority and non-English speaking patients will be enrolled in the study. Patients will be provided with a “What Matters” letter template, will fill it out at home, and send it back to their provider. We will interview patients about their experience writing the letter and discussing it with their provider. We will also interview providers about their experience with this exercise to understand if it reduces barriers that they face when attempting to have values-centered conversations. We will use a qualitative, thematic analysis methodology to evaluate our objectives.

Results

IRB approval for the study was received in September 2024. Currently, we are in the process of informing providers about the research protocol and will begin recruiting provider/patient pairs in October 2024.

Conclusion

We hypothesize that a letter-based approach to discussing “What Matters” can improve the frequency of values-centered conversations in the care of racial minority and non-English speaking patients. Additionally, we hypothesize that this approach can reduce barriers providers encounter when attempting to have these conversations in a high-volume, safety-net primary care setting.

References

1. Xu L, Sommer RK, Nyeko L, et al. Patient Perspectives on Serious Illness Conversations in Primary Care. J Palliat Med. 2022 Jun;25(6):940-944. 2. Abbas M, Chua IS, Tabata-Kelly M, et al. Racial and Ethnic Disparities in Serious Illness Conversation Quality during the COVID-19 Pandemic. J Pain Symptom Manage. 2024 May 22:S0885-3924(24)00785-1. 3. Kim H, Flieger SP. Barriers to Effective Communication about Advance Care Planning and Palliative Care: A Qualitative Study. J Hosp Palliat Care. 2023 Jun 1;26(2):42-50. 4. Hafid A, Howard M, Guenter D, Elston D, Fikree S, Gallagher E, Winemaker S, Waters H. Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program. BMC Palliat Care. 2021 Jul 30;20(1):122. 5. Swiderski D, Georgia A, Chuang E, et al. “I was not able to keep myself away from tending to her immediate needs”: Primary Care Physicians' Perspectives of Serious Illness Conversations at Community Health Centers. J Gen Intern Med. 2022 Jan;37(1):130-136. 6. Periyakoil VS, Neri E, Kraemer H. A Randomized Controlled Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive. J Palliat Med. 2017 Sep;20(9):954-965.