A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making
A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making
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DOI：
10.1111/acem.13214
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发表时间：
2017-08-01
影响因子：
4.4
通讯作者：
Sterling, Sarah
中科院分区：
文献类型：
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作者：
Dehon, Erin;Weiss, Nicole;Sterling, Sarah
目的：急诊科在诊断和治疗少数民族方面存在差异。更好地理解医生的隐性(无意识)偏见是如何导致这些差异的，可能有助于确定消除这种种族差异的方法。该系统综述的目的是检验和总结关于内隐种族偏见与临床决策之间关系的证据。方法：以Prisma指南为基础，对PubMed、CINAHL、Scope us、以及QicINFO数据库进行结构化电子文献检索。符合条件的研究包括：1)包括医生，2)包括内隐联想测试作为内隐偏见的衡量标准，3)包括对医生临床决策的评估，4)在1998至2016年间发表在同行评议的期刊上。两名独立调查人员对纳入的文章进行了审查。数据提取由一名调查员执行，并由另一名调查员检查准确性。结果：在最初检索到的1154篇独特文章中，有9篇研究(n=1,910)符合纳入标准。九项研究中有三项涉及急救提供者，包括住院医生、主治医生和高级实践提供者。大多数研究使用临床片段来检查临床决策。包括急诊药物(EM)提供者在内的研究涉及急性心肌梗死、疼痛和儿童哮喘的治疗。无论专业如何，对白人的隐性偏好在各个供应商中都很常见。在九项研究中，有两项发现了内隐偏见和临床决策之间关系的证据；其中一项研究包括EM提供者。这项研究发现，对白人表现出隐性偏好的EM和内科住院医生更有可能治疗白人患者，而不是黑人患者，接受心肌梗死溶栓治疗。来自这两项研究的证据表明，医生的隐性种族偏见与决策之间的关系质量较低。结论：目前的文献表明，尽管许多医生，无论专业如何，都表现出对白人的隐性偏好，但这种偏见似乎并不影响他们的临床决策。需要进一步研究内隐种族偏见对ED治疗中种族差异的影响。
Objectives: Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED). A better understanding of how physician implicit (unconscious) bias contributes to these disparities may help identify ways to eliminate such racial disparities. The objective of this systematic review was to examine and summarize the evidence on the association between physician implicit racial bias and clinical decision making.Methods: Based on PRISMA guidelines, a structured electronic literature search of PubMed, CINAHL, Scopus, and PsycINFO databases was conducted. Eligible studies were those that: 1) included physicians, 2) included the Implicit Association Test as a measure of implicit bias, 3) included an assessment of physician clinical decision making, and 4) were published in peer-reviewed journals between 1998 and 2016. Articles were reviewed for inclusion by two independent investigators. Data extraction was performed by one investigator and checked for accuracy by a second investigator. Two investigators independently scored the quality of articles using a modified version of the Downs and Black checklist.Results: Of the 1,154 unique articles identified in the initial search, nine studies (n = 1,910) met inclusion criteria. Three of the nine studies involved emergency providers including residents, attending physicians, and advanced practice providers. The majority of studies used clinical vignettes to examine clinical decision making. Studies that included emergency medicine (EM) providers had vignettes relating to treatment of acute myocardial infarction, pain, and pediatric asthma. An implicit preference favoring white people was common across providers, regardless of specialty. Two of the nine studies found evidence of a relationship between implicit bias and clinical decision making; one of these studies included EM providers. This one study found that EM and internal medicine residents who demonstrated an implicit preference for white individuals were more likely to treat white patients and not black patients with thrombolysis for myocardial infarction. Evidence from the two studies reporting a relationship between physician implicit racial bias and decision making was low in quality.Conclusions: The current literature indicates that although many physicians, regardless of specialty, demonstrate an implicit preference for white people, this bias does not appear to impact their clinical decision making. Further studies on the impact of implicit racial bias on racial disparities in ED treatment are needed.