Understanding Social Contributions to Disparities in Depression Care: US and UK

摘要 医生与来自不同种族和社会背景的患者有效沟通的能力是 这对于缩小健康差距至关重要。然而，沟通并不仅仅是医学的任务 专业人员、病人在积极参与他们的护理和获得必要的 实施和继续治疗的信心和能力。内部明显的差异 医疗保健反映了社会因素的相互作用，包括种族、性别、年龄、识字和文化和 引导患者和医生观点的规范性期望。拟议中的调查 旨在帮助理清医生和患者对社会的贡献 可能加剧与提供和接受抑郁症护理和治疗有关的健康差距的偏见 美国和英国的自杀风险评估。为了做到这一点，我们提出了一种新的方法，其中录像带 模拟被用来描绘初级保健中以抑郁症为重点的访问，其中种族和性别 参与者受到了实验性的操纵。在分享就医背景的同时， 模拟的侧重点不同；一种是为了检查医生的认知和临床推理过程 而另一项研究则探讨了患者对接受护理的感知、反应和判断。在 第一项研究(已经收集了数据)向128名美国和英国的医生展示了访问模拟 他们被要求扮演治疗医生的角色，并对他们的临床情况进行叙述性描述 推理。第二项研究显示了模拟的抑郁症就诊，其中患者和医生的性别和 种族被实验性地操纵，在美国和英国，640名不同种族的男性和女性被试。 受试者在模拟中替代扮演抑郁症患者的角色，以提供对他们的 对关怀的认知和情感反应。通过这种方式，我们将能够探索主体如何作为 模拟患者和医生在做出医疗判断时受性别和种族的影响 美国和英国医疗保健体系和社会结构的背景。研究3将测试生态有效性 通过分析不同种族的医生在实际患者数据中的模拟结果 背景已经在一个匿名的数据库中评估了患者的抑郁和自杀风险。

Abstract Physicians' ability to communicate effectively with patients from ethnically and socially diverse backgrounds is essential to reducing health disparities. However, communication is not solely the task of medical professionals, patients also play a critical role in active participation in their care and in gaining the necessary confidence and competence to implement and continue treatment. The disparities that are evident within medical care reflect the interplay of social factors, including race, gender, age, literacy, and the cultural and normative expectations that guide the perspectives of both patients and physicians. The proposed investigation is designed to contribute to the disentangling of physician-derived and patient-derived contributions to social bias that may exacerbate health disparities associated with the provision and receipt of depression care and suicide risk assessment in the US and UK. In order to do so, we propose a novel approach in which videotape simulations are used to portray a depression -focused visit in primary care in which the ethnicity and gender of the participants have been experimentally manipulated. While sharing the context of a medical visit, the simulations differ in focus; one is designed to examine physicians' cognitive and clinical reasoning processes while the other explores patients' perceptions, responses and judgments related to the receipt of care. In the first study (for which data are already collected), visit simulations were shown to 128 US and UK physicians who were asked to take the role of the treating physician and provide a narrative account of their clinical reasoning. The second study shows simulated depression visits, in which patient and physician gender and ethnicity is experimentally manipulated, to 640 ethnically diverse male and female subjects in the US and UK. Subjects vicariously take the role of the depressed patient in the simulations to provide insights into their cognitive and affective reactions to care. In this way, we will be able to explore how subjects acting as analogue patients and physicians are influenced by gender and ethnicity in making medical care judgments in the context of the US and UK health care system and social structure. Study 3 will test the ecological validity of the analogue findings through the analysis of actual patient data in which physicians from different ethnic backgrounds have assessed patients' depression and suicide risk in an anonymised database.