A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test
A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test
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DOI：
10.1016/j.socscimed.2017.05.009
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发表时间：
2018-02-01
影响因子：
5.4
通讯作者：
Johnson, Tiffani J.
中科院分区：
文献类型：
--
作者：
Maina, Ivy W.;Belton, Tanisha D.;Johnson, Tiffani J.
美国少数种族/族裔的护理和结果的差异是有据可查的。研究表明，供应商偏见在这些差异中发挥了作用。内隐联想测验通过测试概念之间的自动联想来测量内隐偏见。数以百计的研究已经在各种环境中检查了内隐偏见，但在医疗保健中进行的相对较少。这篇系统性综述的目的是综合目前关于内隐偏见在医疗差异中的作用的知识。对2015年5月至2016年9月期间的多个数据库进行全面文献检索，确定了37项合格研究。其中，31人发现了支持白人或浅色皮肤/反黑人，西班牙裔，美洲印第安人或深色皮肤偏见的证据，这些偏见存在于多个培训和学科水平的各种HCP中。14项研究使用临床插图或模拟患者检查了内隐偏倚与医疗结果之间的关联。8项研究发现，内隐偏见与患者护理之间没有统计学显著相关性，而6项研究发现，较高的内隐偏见与治疗建议，治疗债券的期望，疼痛管理和同情心的差异有关。所有七项研究，研究了隐式提供者偏见对现实世界的患者提供者互动的影响发现，提供者与更强的隐式偏见表现出较差的患者提供者沟通。两项研究考察了内隐偏倚对现实世界临床结局的影响。一个发现了关联，另一个没有。两项研究测试了旨在减少偏见的干预措施，但只有一项研究发现干预后内隐偏见减少。这篇综述揭示了需要更多的研究探索隐式偏见在现实世界中的病人护理，潜在的修改器和混杂因素的影响，隐式偏见的护理，旨在减少隐式偏见和改善患者提供者的沟通策略。未来的研究有机会建立在目前的研究基础上，这样做将使我们能够实现医疗保健和结果的公平。(C)2017爱思唯尔有限公司版权所有
Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient provider interaction found that providers with stronger implicit bias demonstrated poorer patient provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes. (C) 2017 Elsevier Ltd. All rights reserved.