Conjoint analysis to measure physician discrimination toward African Americans

描述(由申请者提供)：国家研究委员会将歧视定义为“基于对种族群体不利的种族的差别待遇”。数十年的研究发现，好心的医生通过向少数族裔和白人提供不平等的医疗建议来进行歧视。医生的歧视，虽然通常是无意的，但在制造和延续差异方面可能起到重要作用。国家卫生研究所(NIH)(PA-11-164)认识到，迫切需要对医疗保健中的种族歧视进行实证衡量，以减少健康差距。尽管医生的歧视对公共健康造成了严重的影响，但还没有制定出衡量这种歧视的金标准评估方法。到目前为止，用于衡量医生歧视程度的评估方法(如自我报告)具有严重的局限性(如受到社会期望效应的影响)。鉴于以前研究的评估方法的局限性，PA-11-164呼吁进行研究，以“改进医疗保健提供过程中种族/族裔歧视的衡量标准”，以便在我们的医疗保健系统中消除对少数群体的不平等待遇。作为对这一研究呼吁的直接回应，拟议的R03旨在测试一种创新的评估方法-联合分析，以检查患者的种族对医生的治疗建议的作用。联合分析是一种评估方法，要求参与者对计算机生成的一系列小插曲做出反应，这些小插曲因多种因素(例如，假设的患者的种族、收入和健康状况)而有所不同。联合分析具有独特的能力，可以克服以前使用的评估方法的局限性，因为：1)它可以检测社会不受欢迎的影响(例如，歧视)；2)它被发现是一个很好的预测真实世界行为的工具。对于拟议的项目，将使用联合分析来检测医生在提交结直肠癌(CRC)筛查建议(即结肠镜检查、FOBT、FIT)时对非裔美国人的歧视。医生不同的结直肠癌筛查建议可能会直接影响结直肠癌的差异。目的1是检查联合分析是否能检测出患者种族在医生推荐的结直肠癌筛查中的作用。目的2是探索医生对患者健康行为的信念(由联合分析确定)是否会在患者种族与医生建议之间的关系中起到中介作用。目的3是探讨医生特征(例如，性别、种族)是否会调节患者种族与医生的结直肠癌筛查建议之间的关系。为了实现这些目标，我们将招募732名初级保健医生参与联合研究。R03的结果将有助于越来越多的文献研究医生在推荐结直肠癌筛查时对非裔美国人的歧视。

DESCRIPTION (provided by applicant): The National Research Council defines discrimination as "differential treatment on the basis of race that disadvantages a racial group." Decades of research have found that well-intentioned physicians discriminate by providing unequal healthcare recommendations to minorities versus whites. Physicians' discrimination, though often unintentional, can play a significant role in creating and perpetuating disparities. The National Institute of Health (NIH) (PA-11-164) recognizes the critical need to empirically measure racial discrimination in healthcare in order to reduce health disparities. Despite the serious public health repercussions of physicians' discrimination, no gold standard assessment method has yet been developed to measure such discrimination. To date, the assessment methods that have been used to measure physicians' discrimination (e.g., self-report) have serious limitations (e.g., tainted by social desirability effects). Given the limitations in the previously studied assessment methods, PA-11-164 calls for research to "improve the measurement of racial/ethnic discrimination in healthcare delivery" in order to move toward eliminating the unequal treatment of minorities in our healthcare system. In direct response to this call for research, the proposed R03 aims to test an innovative assessment method, conjoint analysis, to examine the role of patients' race on physicians' treatment recommendations. Conjoint analysis is an assessment method that asks participants to respond to a series of computer-generated vignettes that vary on multiple factors (e.g., hypothetical patients' race, income, and health status). Conjoint analysis has the unique ability to overcome the limitations in the previously used assessment methods because: 1) it can detect socially undesirability effects (e.g., discrimination); and, 2) it has been found to be an excellent predictor of real worl behavior. For the proposed project, conjoint analysis will be used to detect physicians' discrimination against African Americans in the delivery of colorectal cancer (CRC) screening recommendations (i.e., colonoscopy, FOBT, FIT). Physicians' differing CRC screening recommendations can have direct consequences on CRC disparities. Aim 1 is to examine whether conjoint analysis can detect the role of patients' race on physicians' recommendations for CRC screenings. Aim 2 is to explore whether physicians' beliefs about patients' health behaviors (as determined by conjoint analysis) will mediate the relationship between patients' race and physicians' recommendations. Aim 3 is to explore whether physician characteristics (e.g., gender, race) moderate the relationship between patients' race and physicians' CRC screening recommendations. To achieve these aims, we will enroll 732 primary care physicians to participate in the conjoint study. The results of the R03 will contribute to the growing literatre on physicians' discrimination toward African Americans in recommending colorectal cancer screenings.