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Black and White caregivers of patients who were critically ill reported racial disparities in clinician spiritual engagement, according to a recent study.

Black and White caregivers of patients who were critically ill and who desired clinician engagement regarding spirituality reported racial disparities in clinician spiritual engagement, according to a study published in Chest Critical Care.

“The goal of this study was to elicit Black and White family caregivers’ perspectives on (1) the influence of religion and spirituality on ICU decision-making and (2) how clinicians and health systems can support their religious and spiritual needs,” wrote Oluwatumilara F. Akeke, MPH, of Icahn School of Medicine at Mount Sinai, and colleagues. “Further, we sought to compare Black and White caregivers’ experiences of and preferences for spiritual support.”

Caregiver Interviews

Between January 3 and May 11, 2023, the investigators conducted 21 semistructured interviews with non‑Hispanic Black and White family caregivers whose loved ones had been admitted to ICUs within a southeastern US health system. Interviews occurred 34 to 291 days after ICU admission. Eligible participants self‑identified as having unmet spiritual needs or placing high importance on spirituality. Caregivers were asked to describe how spirituality informed their health‑related decisions and coping strategies during their loved one’s critical illness.

Of the final cohort, 9 caregivers (42.9%) were Black and 12 caregivers (57.1%) were White. Both groups were predominantly female (77.8% of Black caregivers and 75.0% of White caregivers) and middle‑aged, with mean ages of 50.6 and 61.7 years, respectively. The majority of Black caregivers (77.8%) were adult children of the patients who were critically ill.

Contrasts & Commonalities

Two racially distinct themes emerged: clinicians engaged less frequently with Black caregivers on matters of religion and spirituality compared with White caregivers, and Black family caregivers reported greater ease discussing spiritual concerns within their community networks.

Nonetheless, three universal themes were identified:

• A conviction that God, not the medical team, ultimately controlled patient outcomes
• A preference for accessible spiritual or reflective spaces proximal to the ICU
• A desire for clinicians to initiate dialogue regarding spiritual beliefs

Standardizing Spiritual Care

“Given the high burden of psychological distress among ICU caregivers, standardizing spiritual assessment and care in ICUs may improve the psychological health of caregivers. Whether such care is delivered by ICU clinicians themselves or other care team members should be determined by local workflows and capacity assessments,” the authors concluded. “Instituting structural processes to provide standardized and culturally competent spiritual care to patients and caregivers for whom this is important may improve their experience of critical care.”