Patient activation reduces effects of implicit bias on doctor-patient interactions.
Patient activation reduces effects of implicit bias on doctor-patient interactions.
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DOI：
10.1073/pnas.2203915119
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发表时间：
2022-08-09
影响因子：
11.1
通讯作者：
中科院分区：
文献类型：
--
作者：
黑人和白色美国人之间的差异在医疗和健康结果方面持续存在。原因之一是，医生有时会含蓄地偏爱白色（而不是黑人）患者。本文提出的结果表明，在医患互动过程中，促进更公平的人际治疗的方法。在我们的研究中，黑人和白色演员（“标准化病人”[SP]）接受了培训，在与毫无戒心的医生会面时表现出参与或典型的行为方式。当SP是典型的，医生的内隐种族偏见与种族偏见的人际治疗。然而，当SP参与时，医生的内隐偏见对人际治疗没有影响。这些结果表明，提出问题、为自己辩护、表达担忧或意见的患者可以得到更公正的人际治疗。黑人和白色美国人之间的差异在医疗和健康结果方面持续存在。原因之一是，医生有时持有隐性种族偏见，有利于白色（黑人）患者。因此，打破医生的隐性偏见的影响是促进公平健康结果的一条途径。在目前的研究中，我们测试了一种潜在的机制来短路医生的隐性偏见的影响：患者激活，即，让病人提出问题并为自己辩护。具体来说，我们训练黑人和白色标准化患者（SP）在与毫无戒心的肿瘤学家和初级保健医生预约时处于“激活”或“典型”状态，其中SP声称患有IV期肺癌。支持的想法，病人激活可以促进公平的医患互动，结果表明，医生的隐性种族偏见（测量的隐式关联测试）预测种族偏见的人际治疗中典型的SP（但不是激活SP）之间的SP评级的互动质量和评级从独立的编码员阅读互动成绩单。这项研究支持了先前的工作，表明内隐态度会破坏医疗环境中的人际治疗，并提供了一种确保公平医患互动的策略。
Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes implicitly favor White (over Black) patients. This paper presents results suggesting an approach for promoting more equitable interpersonal treatment during doctor–patient interactions. In our study, Black and White actors (“standardized patients” [SPs]) were trained to behave in an engaged or typical manner during appointments with unsuspecting doctors. When SPs were typical, doctors’ implicit racial bias was associated with racially biased interpersonal treatment. When SPs were engaged, however, doctors’ implicit bias had no effect on interpersonal treatment. These results suggest that patients who ask questions, advocate for themselves, and voice concerns or opinions can receive more fair-minded interpersonal treatment. Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes hold implicit racial biases that favor White (over Black) patients. Thus, disrupting the effects of physicians' implicit bias is one route to promoting equitable health outcomes. In the present research, we tested a potential mechanism to short-circuit the effects of doctors’ implicit bias: patient activation, i.e., having patients ask questions and advocate for themselves. Specifically, we trained Black and White standardized patients (SPs) to be “activated” or “typical” during appointments with unsuspecting oncologists and primary care physicians in which SPs claimed to have stage IV lung cancer. Supporting the idea that patient activation can promote equitable doctor–patient interactions, results showed that physicians’ implicit racial bias (as measured by an implicit association test) predicted racially biased interpersonal treatment among typical SPs (but not among activated SPs) across SP ratings of interaction quality and ratings from independent coders who read the interaction transcripts. This research supports prior work showing that implicit attitudes can undermine interpersonal treatment in medical settings and provides a strategy for ensuring equitable doctor–patient interactions.
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影响因子：
3.5
作者：
Mishel, Merle H.;Germino, Barbara B.;Blyler, Diane
通讯作者：
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影响因子：
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Havranek, Edward P.
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7.6
作者：
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通讯作者：
Schwartz, JLK