(178) Let’s talk about race: Clinician perspectives on navigating conversations around racial disparities in obstetrics

Objective: Discussions around racial disparities in obstetrics occur in varied silos including the media, communities, and medical institutions. Yet, whether and how these discussions occur in the context of the clinician-patient relationship is unknown. We sought to explore clinician perspectives on conversations with patients regarding racial disparities in maternal health using a qualitative approach.

Study Design: We enrolled perinatal clinicians (n=14) across two hospitals within one academic health system from 8/2023-3/2024, purposively sampled by self-identified race/ethnicity and role until thematic saturation was achieved. Semi-structured interviews utilizing the Health Equity Implementation Framework evaluated (a) prior experience with, and (b) optimization of disparities counseling, focusing on clinician-patient race concordance, comfort levels, barriers, ideal circumstances, and recommended content for conversations around racial disparities in maternal health.  Interviews were coded using a content analysis approach by two coders with high inter-rater reliability (k >0.8).

Results: Clinicians universally recognized the impact of race, specifically racism, on US maternal outcomes. Conversations around racial disparities most frequently arose (1) when Black patients voiced fears of dying or concerns about bias in their care, or (2) in the context of recommending aspirin for preeclampsia risk reduction. Black clinicians felt more comfortable with these discussions, attributed to lived experience and practice. While most clinicians agreed that conversations with patients about racial disparities are important, they identified barriers such as fear of patient reactions (particularly with discordant race), time constraints, and unclear actionable response (Table 1). Participant suggestions for facilitating these conversations are shown in Table 2.

Conclusion: These data, alongside ongoing work on the patient perspective, provide the groundwork for guiding clinician-patient conversations on maternal health disparities.