UnBIASED: Understanding Biased patient-provider Interaction And Supporting Enhanced Discourse

项目总结/摘要 女同性恋、男同性恋、双性恋、变性人、酷儿和其他（LGBTQ+）社区的成员更容易 在性取向或性别认同方面，他们比一般人更容易受到歧视。在 医疗保健，例子包括对异性恋的假设，同性恋/变性人恐惧的态度， 忽视LGBTQ+患者的特殊需求。这种歧视导致了病人的贫困- 提供者沟通、求医延迟、护理不公平和健康差异。这种歧视往往 是由于隐性偏见是无意的，因此“隐藏”在病人-提供者的沟通，但联系 与护理不足相关的负面医疗保健经历，以及提供者对以下方面缺乏了解 LGBTQ+医疗需求。由此产生的健康差距表现在LGTBQ+社区， 更容易受到心理健康问题的影响，更高的物质使用率，以及更差的饮食和锻炼 比一般人群的行为。正如我们在父母补助金中所主张的那样， 通过理解和减轻患者之间的互动中表现出的隐性偏见来消除差异 和供应商。为了扩大我们对低收入、种族多样化患者的父母补助， 补充关注LGBTQ+人群。按照与家长补助金目标2相同的研究设计， 拟议的项目将让LGBTQ+患者和初级保健提供者参与设计沟通反馈 隐藏的偏见拟议的项目将使LGBTQ+患者和初级保健提供者参与， 三个目标是（1）评估对隐性偏见的沟通反馈的需求，（2）共同设计原型反馈， 以及（3）通过可用性测试迭代地改进原型反馈。项目调查结果将扩展父 通过提供来自已知发生隐性感染的第二个危重患者人群的设计证据， 导致健康差异的医疗偏见。除了推进我们对隐性偏见的理解， LGBTQ+人群以患者为中心的沟通障碍，这一证据将有助于更强大的 在家长补助金中开发评估和反馈的模式和自动化工具。

Project Summary/Abstract Members of the Lesbian, Gay, Bisexual, Transgender, Queer, and other (LGBTQ+) community are more prone to experience discrimination than the general population based on their sexual orientation or gender identity. In healthcare, examples include assumptions about heterosexuality, homophobic/transphobic attitudes or comments, or neglecting the specific needs of LGBTQ+ patients. This discrimination results in poor patient- provider communication, delays in care-seeking, care inequities, and health disparities. Often such discrimination is due to implicit biases that are unintentional, and thus “hidden” in patient-provider communication, yet linked with negative healthcare experiences associated with inadequate care and lack of provider knowledge about LGBTQ+ health care needs. The resulting health disparities are demonstrated by the LGTBQ+ community having greater susceptibility to mental health issues, higher rates of substance use, and poorer diet and exercise behaviors than the general population. As we argue in the parent grant, there is a dire need to address health disparities by understanding and mitigating implicit bias that manifests within the interactions between patients and providers. To expand our parent grant focus on low income, racially diverse patients, this diversity supplement focuses on LGBTQ+ people. Following the same study design as Aim 2 of the parent grant, the proposed project will engage LGBTQ+ patients and primary care providers to design communication feedback that conveys hidden bias. The proposed project will engage LGBTQ+ patients and primary care providers in three aims to (1) assess needs for communication feedback on implicit bias, (2) co-design prototype feedback, and (3) and iteratively refine prototype feedback through usability testing. Project findings will extend the parent grant by providing design evidence from a second critical patient population known to experience implicit healthcare biases that lead to health disparities. In addition to advancing our understanding of implicit bias as a barrier to patient-centered communication for LGBTQ+ people, this evidence will contribute to more robust models and automated tools for assessment and feedback being developed in the parent grant.