Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients
Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients
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DOI：
10.1370/afm.1442
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发表时间：
2013-01-01
影响因子：
4.4
通讯作者：
Havranek, Edward P.
中科院分区：
文献类型：
--
作者：
Blair, Irene V.;Steiner, John F.;Havranek, Edward P.
我们调查是否临床医生的显性和隐性的种族/种族偏见与黑人和拉丁美洲患者的看法，他们的护理在建立clinical relationships.METHODS我们进行了电话调查，以2,908例患者，分层的种族/种族，并随机选择了134名临床医生谁以前完成了测试的显性和隐性的种族/种族偏见的患者面板。患者完成了初级保健评估调查，其中涉及他们的临床医生的人际治疗，沟通，信任和背景知识。我们从4个分量表中创建了一个以病人为中心的护理的复合测量。结果：临床医生的外显偏倚水平较低，与病人的感知无关。隐式偏倚的水平在临床医生中各不相同，与白色患者的参考组相比，黑人患者对隐式偏倚较大的患者在以患者为中心的护理中的评分较低（P = .04）。拉丁美洲患者给予临床医生较低的评级比其他群体（P < .0001），这并不依赖于临床医生的内隐偏见（P = .98）。结论这是第一个研究，调查临床医生的内隐偏见和沟通过程中正在进行的临床关系。我们的研究结果表明，临床医生的隐性偏见可能会危及他们与黑人患者的临床关系，这可能会对其他护理过程产生负面影响。因此，这一发现支持了医学研究所的建议，即临床医生的偏见可能会导致健康差异。拉丁美洲人对他们的临床医生的整体更大的关注似乎是基于护理方面而不是临床医生的偏见。Ann Fern Med 2013;11：43-52. doi：10/1370/afm.1442。
PURPOSE We investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships.METHODS We administered a telephone survey to 2,908 patients, stratified by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales.RESULTS Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P < .0001), and this did not depend on the clinicians' implicit bias (P = .98).CONCLUSIONS This is among the first studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our findings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias. Ann Fern Med 2013;11:43-52. doi:10/1370/afm.1442.