Race Dialogues and Potential Application in Clinical Communication: A Scoping Review

Summary Description: Clinicians and society increasingly recognize the impact of structural Racism on public and personal health, and recent work calls for the application of antiracist practices to medicine in order to acknowledge and reduce disparities. Race dialogues are one proposed tool. This is a scoping review seeking to (1) describe evidence of the benefits, best-practices facilitators, and challenges related to race dialogues, and (2) develop an understanding of the potential role of group or interpersonal race dialogues in healthcare (in the education/training setting, in clinician practice, in healthcare spaces, etc.). ************* Background: Group discussions on the topic of race and racism, which have been called race dialogues, have been identified and utilized as a means to introduce viewpoint-sharing and educational self-expression among individuals of different backgrounds. While we generally consider race dialogues to be interpersonal or group conversations about race, for the purposes of this work, we also use the Racial Equity Toolkit’s description of dialogues to further illustrate the qualities of conversations included under our definition: “Dialogue strategies are linked with community engagement strategies, focusing on bringing people together to discuss a particular issue, and/or to build relationships…these strategies [have been described] as methods for practicing democracy and for raising the voices of marginalized groups, and/or of multiple perspectives in a community. Some dialogue processes are designed explicitly as a first step towards action and change; some are not. Most share goals of increasing the number of perspectives that are brought to bear on a community issue” [1]. Race dialogues aim for participants to explore their social identities and experiences in relation to those of others, which in turn invites understanding, empathy and cooperation between them [2]. This may ultimately translate to decreased/managed racial biases and increased anti-racist action among dialogue participants. Ultimately, race dialogues are a proposed communication tool for bridging gaps between people of different backgrounds, yet while there is much to be gained from race dialogues, their setup is crucial and their potential impact dependent on many factors. Despite ideally benefiting their participants, these conversations can easily be inefficacious, or worse, introduce antagonism, if not carried out carefully [3]. Productive dialogues require an intentional and informed setup; if participants are discussing an event, they must share the same understanding beforehand of the “historical, factual realities of the systems surrounding the event that’s at the center of the dialogue” [4]. Additionally, as described by Miller and Donner, race dialogues (and their impact) will vary depending on (1) who participates in the conversation, (2) who sponsors the dialogue and where does the dialogue take place, (3) whether the dialogue is a single event or ongoing relationship, (4) how the group is facilitated, (5) how structured the conversations are, and (6) the goal of the conversation – these factors are important to consider when structuring a dialogue, as unequal power across participants could pre-emptively hinder constructive, purposeful communication [2]. Over the years, researchers and institutions have called for race dialogues and endeavored to develop guidelines and other important curricula for carrying out these conversations [5]. Notably, in 1998, President Clinton released the One America Dialogue Guide (“One America in the 21st Century: The President’s Initiative on Race”) [6], which encouraged open, honest discussions about race in order to deepen Americans’ understanding of one another’s viewpoints. This guide offered definitions and background information, directions for organizing community dialogues on race, and additional resources relevant to the topic; while the guide was important at the time it was published, research informing race dialogues and their challenges and benefits has only expanded – contemporary research may inform important adjustments to prior guidelines that better align with today’s environment. The research on race dialogues is primarily housed within the field of general education, as findings and resources are directly applicable to implementation in the classroom. The fields of business, sociology, psychology, and medicine have also grown burgeoning epistemological bases concerning race dialogues and effective implementation strategies. Given our interest in the potential application of race dialogues as a strategy/practice within the clinical setting, all fields in which race dialogues are studied are of pertinence and interest to us. While race dialogues have been increasingly referenced in the biomedical literature (‘race dialogue’ papers first began gaining popularity in the mid-1990’s (~5 papers with the keyword published per year) and grew more significantly in popularity in the mid 2010’s (~20 papers/year) [7], consideration of in-field work alone would perhaps mean omitting crucial insights highlighted by contemporary research on race dialogues in education, for example. Rationale: Clinicians and society increasingly recognize the impact of structural Racism on public and personal health [8–10]. Black Americans and other minority groups experience more illness, lower healthcare utilization, worse outcomes, and earlier death compared with whites [11,12], all of which are affected by the limited access to socioeconomic resources owing to a history of discrimination [13]. Recent work calls for the application of antiracist practices to medicine in order to acknowledge and reduce disparities [14–18]. Yet, many clinicians are uncertain about how to address racism or employ these practices; race dialogues are one such proposed tool. As few who wish to facilitate race dialogues seek or receive instructions for carrying them out, many clinicians may be unprepared for carrying out productive race dialogues. While some may use dialogue guidelines, these may not be up-to-date and may fail to reflect all information and best practices relevant to healthcare settings. Given the vulnerability and sensitivity involved in discussions about race, implementing race dialogues too quickly may lead to their poor handling and could harm rather than improve relationships. Additionally, while in theory, race dialogues foster understanding and connection among people from different groups, outcomes in the research setting should support this aim – outcomes evidencing the overall benefit of race dialogues could support the use of this practice in clinical contexts and inform clinicians of critical limitations. The lack of relevant research on race dialogues in the biomedical field and the exploratory nature of our aims lend themselves to a scoping review approach with a broader search field. We want to perform this scoping review of the applicable literature concerning race dialogues in multiple fields to summarize their benefits and potential use as a relationship-facilitating tool within the healthcare system (in the education/training setting, in clinician practice, in healthcare spaces, etc.), in order to support the implementation and suggestion of this practice. Objectives: Our objective is to review the literature on race dialogues within the biomedical, psychology, nursing and allied health, anthropology, sociology, and education databases and describe cumulative findings related to their benefits, best practices, and challenges, as well as their relevance within the healthcare setting. Ultimately, in reviewing the literature, we hope to: • (1) describe evidence of the benefits, best-practices facilitators, and challenges related to race dialogues. • (2) understand the potential role of group or interpersonal race dialogues in healthcare (in the education/training setting, in clinician practice, in healthcare spaces, etc.). *********** References: 1 Racial Equity Tools. Act, Strategies, Dialogue and Deliberation. Racial Equity Tools. 2020. URL: https://www.racialequitytools.org/resources/act/strategies/dialogue-and-deliberation (Accessed 22 July 2021). 2 Miller J, Donner S. More than just talk: The use of racial dialogues to combat racism. Social Work with Groups 2000;23:31–53. https://doi.org/10.1300/J009v23n01_03. 3 Sue DW. Race talk and facilitating difficult racial dialogues. Counseling Today 2015. 4 Demby G. Why Calls For Racial Dialogue Rarely Lead To Actual Conversations. NPR 2019. 5 Learning for Justice. Let’s Talk: Facilitating Critical Conversations with Students. Teaching Tolerance 2015. 6 Clinton W. One America in the 21st Century: The President’s Initiative on Race. Washington, DC: The White House; 1998. 7 Slater L. PubMed PubReMiner. Journal of the Canadian Health Libraries Association / Journal de l’Association Des Bibliothèques de La Santé Du Canada 2014;33:undefined-undefined. https://doi.org/10.5596/c2012-014. 8 Devakumar D, Selvarajah S, Shannon G, Muraya K, Lasoye S, Corona S, et al. Racism, the public health crisis we can no longer ignore. The Lancet 2020;395:e112–3. https://doi.org/10.1016/S0140-6736(20)31371-4. 9 AMA Press Center. New AMA policy recognizes racism as a public health threat. American Medical Association. 2020. URL: https://www.ama-assn.org/press-center/press-releases/new-ama-policy-recognizes-racism-public-health-threat (Accessed 22 July 2021). 10 O’Reilly K. AMA: Racism is a threat to public health. American Medical Association. 2020. URL: https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health (Accessed 22 July 2021). 11 National Center for Health Statistics (US). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD: National Center for Health Statistics (US); 2016. 12 National partnership for action to end healt

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