Project Inclusive Genetics: Protecting reproductive autonomy from bias via prenatal patient-centered counseling.
Project Inclusive Genetics: Protecting reproductive autonomy from bias via prenatal patient-centered counseling.
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DOI：
10.1016/j.xhgg.2023.100228
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发表时间：
2023-10-12
期刊：
影响因子：
--
通讯作者：
Dasgupta, Shoumita
中科院分区：
文献类型：
--
作者：
Jungels, Apolline;Demers, Lindsay;Ford, Eric;Stevens, Blair K.;Sabatello, Maya;Dasgupta, Shoumita
临床医生的偏见对边缘化社区获得的医疗保健产生了负面影响。在这项研究中，我们探讨了影响临床医生和实习生对智障人士的偏见的因素，以及在产前基因测试环境中对临床判断的影响。具体地说，我们检查了对有较高残疾机会的胎儿的偏见。我们比较了遗传学专家和他们的非专家同行。这项基于网络的研究包括临床小插曲、内隐联想测试(IATS)和一个教育模块。通过他们所在的机构或专业协会招募了595名参与者。我们进行了统计分析，包括控制关键人口统计特征的回归模型，以分析模块完成后的推荐模式和变化程度。当患者不考虑终止妊娠时，遗传学专业知识与适当的检测建议密切相关(模块前r=1.784，模块后r=1.502，p<0.01)。影响模块前推荐测试的因素包括年龄增加(r=−0.029，p<0.05)，高度虔诚(r=0.525，p<0.05)，以及参与者个人对测试的偏好(r=1.112，p<0.01)。没有遗传学专业知识的参与者在教育模块后的反应有所改善(Z=−4.435，p<0.01)。42%的回答不当的非专家在模块结束后更改了他们的答案，以符合指导方针。个人偏见以及结构性和制度性偏见渗透到计划生育的遭遇中，并显著降低了护理质量。我们在这里证明，反偏见培训是有效的，特别是对非专家提供者，它可以改善向智障人士提供的护理。像这样的循证培训可以帮助提供者提出适当的遗传咨询建议。在产前接触中，临床医生和实习生的偏见会影响临床建议，特别是关于胎儿残疾的可能性。我们报告了影响有偏见的建议的因素。我们还评估了我们的培训模块，它提高了在临床小插曲中提出以指南为导向、以患者为中心的临床建议的可能性。
Clinician bias negatively impacts the healthcare received by marginalized communities. In this study, we explored factors that influence clinician and trainee bias against individuals with intellectual disabilities and its impact on clinical judgment in prenatal genetic testing settings. Specifically, we examined bias toward a fetus with a higher chance of developing a disability. We compared genetics specialists with their non-expert counterparts. This web-based study included clinical vignettes, implicit association tests (IATs), and an educational module. 595 participants were recruited via their institution or professional society. We conducted statistical analyses, including regression models controlling for key demographic characteristics, to analyze recommendation patterns and degree of change after the module. Genetics expertise strongly correlated with appropriate testing recommendation when the patient would not consider pregnancy termination (r = 1.784 pre-module, r = 1.502 post-module, p < 0.01). Factors that influenced pre-module recommendation to test include increased age (r = −0.029, p < 0.05), high religiosity (r = 0.525, p < 0.05), and participant personal preference against testing (r = 1.112, p < 0.01). Responses among participants without genetics expertise improved after the educational module (Z = −4.435, p < 0.01). 42% of non-experts who answered inappropriately changed their answer to match guidelines after the module. Individual bias, along with structural and institutional bias, permeates family planning encounters and significantly decreases quality of care. We demonstrate here that anti-bias training is effective, particularly for non-expert providers, and it can improve the care provided to individuals with intellectual disability. Evidence-based training such as this one can help providers make appropriate genetic counseling recommendations. In prenatal encounters, clinicians and trainee bias can impact clinical recommendations, particularly regarding the possibility of a fetus with a disability. We report factors that influence biased recommendations. We also evaluate our training module, which improves the likelihood of making guideline-directed, patient-centered clinical recommendations in clinical vignettes.
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1.9
作者：
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Banaji, Mahzarin R.