Genetic counselor implicit bias and its effects on cognitive and affective exchanges in racially discordant simulations
Genetic counselor implicit bias and its effects on cognitive and affective exchanges in racially discordant simulations
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DOI：
10.1002/jgc4.1243
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发表时间：
2020-03-06
影响因子：
1.9
通讯作者：
Roter, Debra L.
中科院分区：
文献类型：
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作者：
Lowe, Chenery L.;Beach, Mary Catherine;Roter, Debra L.
以前的研究已经将临床医生的隐性种族偏见与医疗服务提供者和患者在各种医疗环境中以患者为中心的沟通联系起来。本研究扩展了这一研究，探讨了遗传咨询师（GC）促进模拟客户的认知和情绪处理在遗传咨询会议期间的内隐种族偏见的影响。我们进行了二次分析的遗传咨询会议的全国代表性样本的白色和少数民族和/或种族（黑人和拉丁裔）的模拟客户与60个GC的子集谁完成了种族内隐关联测试（IAT）。语言查询字数（LIWC）被应用到会话记录，以确定由模拟客户端的情绪和认知处理一致的词的使用。Roter互动分析系统（RIAS）被用来连接GC语句与促进情绪和认知处理，如在以前的研究中使用的。进行多元线性回归分析，将LIWC和RIAS变量与GC IAT评分、客户种族/民族以及GC IAT评分与客户种族/民族之间的统计相互作用联系起来。GC使用更多的认知促进策略与少数民族和/或种族比与白色客户（p = .04）。GC的亲白内隐偏见和GC的促进认知和情感处理或客户使用积极，消极或认知过程的话之间没有统计学显著性关联。虽然内隐偏见可能会影响一些沟通过程，但我们的分析并未显示GC IAT评分与GC如何帮助客户处理会话期间传达的情感或认知信息之间的关系。也有可能，认知和情绪处理的LIWC测量不是一个足够敏感的措施，以捕捉一个隐含的偏见效应，如果确实存在。
Previous studies have linked clinicians' implicit racial bias with less patient-centered communication between healthcare providers and patients in a variety of healthcare contexts. The current study extends this research by exploring the influence of implicit racial bias in genetic counselors' (GCs') facilitation of simulated clients' cognitive and emotional processing during genetic counseling sessions. We conducted a secondary analysis of a nationally representative sample of genetic counseling sessions of White and ethnic and/or racial minority (Black and Latinx) simulated clients with a subset of 60 GCs who had completed a Race Implicit Association Test (IAT). Linguistic Inquiry Word Count (LIWC) was applied to session transcripts to identify word use by the simulated client consistent with emotional and cognitive processing. The Roter Interaction Analysis System (RIAS) was used to link GC statements consistent with facilitation of emotional and cognitive processing, as used in previous studies. Multiple linear regression analyses were performed to relate LIWC and RIAS variables to GC IAT scores, client race/ethnicity, and statistical interaction between GC IAT scores and client race/ethnicity. GCs used more cognitive facilitation strategies with ethnic and/or racial minority than with White clients (p = .04). There were no statistically significant associations between GCs' pro-White implicit bias and GCs' facilitation of cognitive and emotional processing or clients' use of positive, negative, or cognitive process words. While implicit bias may affect some communication processes, our analysis did not show a relationship between GC IAT score and how GCs help clients process emotional or cognitive information conveyed during a session. It is also possible that the LIWC measure of cognitive and emotional processing is not a sensitive enough measure to capture an implicit bias effect if indeed one is present.