Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
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DOI：
10.1371/journal.pone.0257794
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Shields CG
中科院分区：
文献类型：
--
作者：
Fiscella K;Epstein RM;Griggs JJ;Marshall MM;Shields CG
内隐种族偏见影响许多人际交往，包括病人与医生的接触。然而，其影响因研究而异。我们使用随机现场实验评估了医生隐性种族偏见对癌症相关疼痛管理的影响。我们对2012年至2016年期间的一项随机现场实验进行了分析，96名初级保健医生和肿瘤学家使用了未经宣布的黑人和白色标准化患者（SP），这些患者报告了转移性肺癌引起的不受控制的骨痛。我们评估内隐偏见使用的痛苦适应种族内隐联想测试。我们通过审查医疗记录和处方来评估临床护理，我们评估了未经宣布的标准化患者办公室访问的编码抄本和秘密录音带的通信。我们评估了医生的内隐偏见和SP种族与临床护理和沟通结果的相互作用的影响。我们进行了斜率分析，以检查显着的相互作用的性质。正如假设的那样，具有较大隐式偏见的医生为黑人SP提供了较低质量的护理，包括指定阿片类药物处方的更新较少，以患者为中心的疼痛沟通较少，但常规疼痛评估相似。与我们的其他假设相反，医生的内隐偏见并没有与SP种族的预后沟通或口头优势。交叉相互作用的斜率分析显示，更大的医生偏倚表现为白色SP更频繁的阿片类药物处方和更多的疼痛讨论，而黑人SP的处方和疼痛谈话频率略低，在具有较低隐式偏倚的医生中效果相反。结果是有限的使用未经验证的，疼痛适应IAT。使用SP方法，医生的隐性偏见与转移性肺癌相关的不受控制的疼痛管理的临床意义，种族差异。根据内隐偏见的水平，对白色或黑色SP有有利的待遇。
Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field experiment. We conducted an analysis of a randomized field experiment between 2012 and 2016 with 96 primary care physicians and oncologists using unannounced, Black and White standardized patients (SPs)who reported uncontrolled bone pain from metastatic lung cancer. We assessed implicit bias using a pain-adaptation of the race Implicit Association Test. We assessed clinical care by reviewing medical records and prescriptions, and we assessed communication from coded transcripts and covert audiotapes of the unannounced standardized patient office visits. We assessed effects of interactions of physicians’ implicit bias and SP race with clinical care and communication outcomes. We conducted a slopes analysis to examine the nature of significant interactions. As hypothesized, physicians with greater implicit bias provided lower quality care to Black SPs, including fewer renewals for an indicated opioid prescription and less patient-centered pain communication, but similar routine pain assessment. In contrast to our other hypotheses, physician implicit bias did not interact with SP race for prognostic communication or verbal dominance. Analysis of the slopes for the cross-over interactions showed that greater physician bias was manifested by more frequent opioid prescribing and greater discussion of pain for White SPs and slightly less frequent prescribing and pain talk for Black SPs with the opposite effect among physicians with lower implicit bias. Findings are limited by use of an unvalidated, pain-adapted IAT. Using SP methodology, physicians’ implicit bias was associated with clinically meaningful, racial differences in management of uncontrolled pain related to metastatic lung cancer. There is favorable treatment of White or Black SPs, depending on the level of implicit bias.
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影响因子：
28.4
作者：
Epstein RM;Duberstein PR;Fenton JJ;Fiscella K;Hoerger M;Tancredi DJ;Xing G;Gramling R;Mohile S;Franks P;Kaesberg P;Plumb S;Cipri CS;Street RL Jr;Shields CG;Back AL;Butow P;Walczak A;Tattersall M;Venuti A;Sullivan P;Robinson M;Hoh B;Lewis L;Kravitz RL
通讯作者：
Kravitz RL
影响因子：
2.5
作者：
Alexander, Jeff;Hearld, Larry;Mittler, Jessica N.
通讯作者：
Mittler, Jessica N.
影响因子：
5.4
作者：
Hagiwara, Nao;Penner, Louis A.;Albrecht, Terrance L.
通讯作者：
Albrecht, Terrance L.
影响因子：
4.4
作者：
Blair, Irene V.;Steiner, John F.;Havranek, Edward P.
通讯作者：
Havranek, Edward P.
影响因子：
7.6
作者：
Greenwald, AG;Nosek, BA;Banaji, MR
通讯作者：
Banaji, MR