Racial Inequities, Shared Decision-Making, and Trauma-Informed Critical Care with Dr. Deepshikha Ashana

Bioethics in the Margins

In this episode, Kirk and Amelia speak with Dr. Deepshikha Ashana about her research on racial disparities present in shared decision-making practices in critical care. Dr. Ashana shares how her research interests were motivated by her personal observations of racial disparities, from her childhood in India, her experience moving to the US, and her education in Philadelphia. Her recent research thematically analyzed audio recordings of conversations between families and clinicians of critical care patients, using inductive analysis to identify four ways that communication behaviors differed in clinicians’ engagement with racially minoritized families. She discussed the racialized empathy gap, how cultural health capital is received differently from Black versus white families, and the striking disagreements in self-reports of conflict between clinicians and family members that fall along racial lines. She also discussed the importance for critical care clinicians to be trained in trauma-informed practices. In thinking about what is next in her research, she highlighted the importance of finding effective ways to mitigate the effects of structural racism on the healthcare system which go beyond the limitations of implicit bias training, and she emphasized her passion for empowering clinicians to offer the best care possible.

Dr. Ashana is an assistant professor of medicine in Duke’s Division of Pulmonary and Critical Care and a practitioner in the Duke University Hospital medical intensive care unit and at Duke Health Center at Southpoint. Her research focuses on understanding and addressing mechanisms of differences in critical illness care among underserved patients. She uses mixed methods to study epidemiologic trends in national health claims data and understand patient perspectives on serious illness care, with a particular focus on modifiable clinician and health system factors. Her work can be found here: https://medicine.duke.edu/profile/deepshikha-ashana

Referenced articles: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2815259

https://www.atsjournals.org/doi/10.1513/AnnalsATS.201909-700IP