Conjoint analysis to measure physician discrimination toward African Americans

联合分析衡量医生对非裔美国人的歧视

• 批准号: 8601058
• 负责人: Sarah J Miller
• 金额: $ 8.22万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8601058
• 关键词: African American; Behavior; Belief; Characteristics; Colonoscopy; Colorectal Cancer; Conscious; Data; Disadvantaged; Discrimination; Enrollment; Gender; Gold; Health Status; Health behavior; Healthcare; Healthcare Systems; Hispanics; Income; Individual; Institute of Medicine (U.S.); Intervention; Laboratories; Light; Measurement; Measures; Mediating; Medical; Methodology; Methods; Minority; Minority Groups; Modeling; Morbidity - disease rate; National Research Council; Obesity; Participant; Patient Self-Report; Patients; Physicians; Play; Primary Care Physician; Primary Health Care; Public Health; Questionnaires; Race; Recommendation; Regression Analysis; Research; Role; Series; Social Desirability; Testing; Unconscious State; United States National Institutes of Health; Woman; base; cancer health disparity; colorectal cancer screening; computer generated; ethnic discrimination; health care delivery; health disparity; improved; innovation; interest; mortality; prospective; public health relevance; racial and ethnic; racial discrimination; response; sound; uptake

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.

描述（由申请人提供）：国家研究委员会将歧视定义为“基于种族的、对某个种族群体不利的差别待遇”。数十年的研究发现，善意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。医生的歧视虽然常常是无意的，但可能在造成和延续不平等方面发挥重要作用。美国国立卫生研究院 (NIH) (PA-11-164) 认识到迫切需要根据经验衡量医疗保健中的种族歧视，以减少健康差距。尽管医生歧视对公共健康造成了严重影响，但尚未制定出衡量这种歧视的金标准评估方法。迄今为止，用于衡量医生歧视的评估方法（例如自我报告）具有严重的局限性（例如受到社会期望效应的影响）。鉴于先前研究的评估方法的局限性，PA-11-164 呼吁研究“改进医疗保健服务中种族/民族歧视的衡量标准”，以消除我们医疗保健系统中少数群体的不平等待遇。为了直接响应这一研究呼吁，拟议的 R03 旨在测试一种创新的评估方法（联合分析），以检查患者种族对医生治疗建议的作用。联合分析是一种评估方法，要求参与者对一系列计算机生成的小插图做出反应，这些小插图因多种因素（例如假设患者的种族、收入和健康状况）而异。联合分析具有克服先前使用的评估方法的局限性的独特能力，因为：1）它可以检测社会不良影响（例如歧视）；并且，2）它被发现可以很好地预测现实世界的行为。对于拟议的项目，联合分析将用于检测医生在提供结直肠癌 (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 CRC 筛查建议可能会对 CRC 差异产生直接影响。目标 1 是检验联合分析是否可以检测患者种族对医生建议的 CRC 筛查的影响。目标 2 是探讨医生对患者健康行为的看法（通过联合分析确定）是否会调节患者种族和医生建议之间的关系。目标 3 是探讨医生特征（例如性别、种族）是否调节患者种族与医生 CRC 筛查建议之间的关系。为了实现这些目标，我们将招募 732 名初级保健医生参加联合研究。 R03 的结果将有助于越来越多的文献报道医生在推荐结直肠癌筛查时对非裔美国人的歧视。