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，尤其是种族/族裔之间的决策 少数民族。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 由于治疗的主观性质，包括心脏移植和左心室辅助装置 过程。隐性偏见在医学领域已得到充分研究，但尚未发现具有普遍作用 在改变结果方面，医疗保健团体决策尚未得到充分研究。因此， 应用混合方法来研究个体医疗保健提供者偏见和群体决策是 创新。首次提出“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模拟量表调查来评估个体提供者的偏见， 以及 de Groot 批判性反射诊断协议，对反射组进行有条理的量化 决策，将用于评估集团决策过程，以选择候选人 心力衰竭的先进疗法。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。该因素的客观测量将用于 用于评估患者先进疗法的标准化协议。实施的自然评价 该协议的制定将导致协议定制，为务实的 R01 试验提供基础。研究结果 这项研究还将对使用多学科医疗保健提供者进行治疗的其他人群产生影响 决策，例如选择经导管主动脉瓣置换术和移植的患者 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.