Physicians' Perceptions of Race and Engagement in Race-Based Clinical Practice: a Mixed-Methods Systematic Review and Narrative Synthesis.
Physicians' Perceptions of Race and Engagement in Race-Based Clinical Practice: a Mixed-Methods Systematic Review and Narrative Synthesis.
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医生对种族的看法和参与基于种族的临床实践：混合方法系统回顾和叙述综合。
DOI：
10.1007/s11606-022-07737-5
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发表时间：
2022
影响因子：
5.7
通讯作者：
Dave,Gaurav
中科院分区：
文献类型：
--
作者：
Okah,Ebiere;Glover,LáShauntá;Donahue,KatrinaE;Corbie-Smith,Giselle;Dave,Gaurav
背景使用种族（一种不能充分捕捉人类遗传变异的社会分配身份）来指导临床护理可能会导致种族少数患者的不良结果。本研究评估了 (1) 医生如何在临床护理中概念化和使用种族（基于种族的护理）和 (2) 与基于种族的护理相关的医生特征。方法检索了 PubMed、CINAHL、EMBASE 和 Scopus 数据库。其中包括以同行评审的英文期刊文章撰写的定性、定量和混合方法研究，评估美国医生对种族的看法以及与基于种族的护理相关的医生因素。使用混合方法评估工具评估偏倚风险。使用主题分析对定性研究进行评估，并对定量研究结果进行总结，并在叙述性综合中与定性研究结果相结合。结果共识别出 1149 篇文章； 9 项（4 项定性，5 项定量）研究符合纳入标准。出现了五个主题：（1）相信种族是生物学的； (2) 利用种族来了解患者的健康状况； (3) 利用种族来为患者提供咨询并确定护理方案； (4) 基于种族的做法的理由（基于证据、个人经验、解决差异、提供个性化护理、提高依从性）； (5) 对基于种族的实践的担忧（对患者特征描述不佳、差异正常化、患者不信任、临床医生不适、生物种族合法化）。在定量研究中，年龄较大与基于种族的护理呈正相关。讨论医生对种族有不同的看法，但许多人认为种族是生物学的。对基于种族的实践的关注和支持与关于在护理中使用种族的证据以及种族作为医学研究中的变量的适当性的信念有关。年长的医生更有可能使用种族，这可能是由于更多地接触基于种族的医学文献，以及种族概念的代际差异。需要对医生种族观念的演变以及医学文献在塑造这些观念中的作用进行更多研究。
BackgroundUsing race—a socially assigned identity that does not adequately capture human genetic variation—to guide clinical care can result in poor outcomes for racially minoritized patients. This study assessed (1) how physicians conceptualize and use race in their clinical care (race-based care) and (2) physician characteristics associated with race-based care.MethodsPubMed, CINAHL, EMBASE, and Scopus databases were searched. Qualitative, quantitative, and mixed-methods studies written in peer-reviewed, English-language journal articles evaluating US physicians’ perceptions of race and physician factors associated with race-based care were included. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were evaluated using thematic analysis, and quantitative findings were summarized and combined with qualitative findings in a narrative synthesis.ResultsA total of 1149 articles were identified; 9 (4 qualitative, 5 quantitative) studies met inclusion criteria. Five themes emerged: (1) the belief in race as biological; (2) the use of race to contextualize patients’ health; (3) the use of race to counsel patients and determine care; (4) justifications for race-based practice (evidence-based, personal experience, addresses disparities, provides personalized care, increases compliance); and (5) concerns with race-based practice (poorly characterizes patients, normalizes disparities, patient distrust, clinician discomfort, legitimized biological race). In quantitative studies, older age was positively associated with race-based care.DiscussionPhysicians had varied perceptions of race, but many believed race was biological. Concern and support for race-based practice were related to beliefs regarding the evidence for using race in care and the appropriateness of race as a variable in medical research. Older physicians were more likely to use race, which could be due to increased exposure to race-based medical literature, in addition to generational differences in conceptualizations of race. Additional research on the evolution of physicians’ perceptions of race, and the role of medical literature in shaping these perceptions, is needed.