Addressing Individual Provider Bias and Group Decision-Making in Selection of Advanced Heart Failure Therapies in Racial/Ethnic Minorities

摘要 偏见存在于生活的多个方面，并影响决策，特别是在种族/民族之间 少数族裔。偏见也可能在选择晚期心力衰竭候选人的过程中发挥重要作用 治疗，包括心脏移植和左心室辅助装置，因为 进程。内隐偏见在医学上已经得到了很好的研究，但还没有发现是普遍有用的。 在改变结果方面，医疗保健群体决策还没有得到很好的研究。因此， 应用混合方法研究个体医疗服务提供者的偏见和群体决策 创新。第一次，大声思考协议，一种阐明决策思想的方法 将使用主题定性分析和视觉类比标尺调查来评估个别提供者的偏见， 以及德格鲁特临界反射诊断方案，这是一种对反射组进行系统量化的方案 决策，将用于评估遴选候选人的群体决策过程 心力衰竭的高级治疗。我们将确定一个最重要的主观因素， 种族/民族偏见和较低的反思分数。这一因素的客观测量将用于 评估患者接受高级治疗的标准化方案。对实施的自然主义评价 该协议的实施将导致协议的定制，为务实的R01试验奠定基础。调查结果 这项研究的结果也将对其他使用多学科医疗保健提供者的人群产生影响 经导管主动脉瓣置换术和心脏瓣膜移植患者选择等决策 其他器官。

ABSTRACT Bias is present in multiple facets of life and influences decision-making particularly among racial/ethnic minorities. Bias also likely plays a strong role in the process of selecting candidates for advanced heart failure therapies, including heart transplants and left ventricular assist devices, because of the subjective nature of the process. Implicit bias has been well studied in medicine but has not been found to be universally instrumental in changing outcomes, and healthcare group decision-making has not been well studied. Therefore, the application of mixed-methods to study individual healthcare provider bias and group decision-making is innovative. For the first time, the think aloud protocol, a method of elucidating decision-making thoughts for thematic qualitative analysis, and a visual analog scale survey will be used to assess individual provider bias, and the de Groot Critically Reflective Diagnosis protocol, a methodical quantification of reflective group decision-making, will be used to assess the group decision-making process for selection of candidates for advanced therapy for heart failure. We will identify the single most important subjective factor that contributes to racial/ethnic bias and lower reflective scores. An objective measurement of this factor will be used in a standardized protocol for evaluating patients for advanced therapies. Naturalistic evaluation of implementation of this protocol will lead to protocol tailoring that will provide groundwork for a pragmatic R01 trial. The findings of this study will also have implications for other populations that use multidisciplinary healthcare providers for decision-making such as selection of patients for transcatheter aortic valve replacement and transplantation of other organs.