Hidden in Plain Sight: Stigmatizing Language in Patient Medical Records

隐藏在众目睽睽之下：患者病历中的污名化语言

• 批准号: 10791987
• 负责人: MARY CATHERINE BEACH
• 金额: $ 32.66万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10791987
• 关键词: Address; Age; Attitude; Behavior; Belief; Bioethical Issues; Bioethics; Bioethics Consultants; British; Canis familiaris; Caring; Categories; Communities; Conceptions; Disparity; Drug Prescriptions; Education; Elderly; Equilibrium; Equity; Ethics; Ethnic Population; Formulation; Future; Gender; Goals; Health Occupations; Health Professional; Healthcare; Healthcare Systems; Impaired health; Individual; Infant; Informed Consent; International; Journals; Language; Learning; Measures; Medical; Medical Ethics; Medical Records; Moral Obligations; Morals; Nature; Obesity; Parents; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Policies; Politics; Publishing; Race; Reading; Research; Risk; Role; Sampling; Science Policy; Sickle Cell Anemia; Speech; Stigmatization; Structural Racism; Substance Use Disorder; Taxonomy; Testing; Text; United States National Institutes of Health; Vision; Work; Writing; clinical practice; experience; health care quality; health inequalities; improved; low health literacy; marginalization; marginalized population; medical specialties; member; oral communication; patient health information; racial disparity; racial population; response; shared decision making; suicidal individual

ABSTRACT Patients are not treated equally in our healthcare system. Those from marginalized racial/ethnic groups, older adults, and individuals with low health literacy, obesity, sickle cell disease, and substance use disorders are often viewed negatively by health professionals in a way that adversely impacts their healthcare quality. While many contributors to such disparities, bias among clinicians toward patients is one important factor. The overarching goal of the parent study is to improve the quality and equity of care for persons who are disrespected and/or stigmatized in healthcare. The parent study specific aims are to (1) develop a taxonomy of stigmatizing language in medical records, (2) measure and test for bias in the use of such language, and (3) reduce its use. The central premise of this supplemental proposal is that this lack of respect for patients, and the resultant stigmatizing language that appears in their medical records, is facilitated by an insufficient set of bioethical and professional norms that fail to describe fully the moral obligation clinicians have to respect patients as persons. For nearly half century, the ethical education of health professionals has been dominated by Beauchamp and Childress's Principles of Biomedical Ethics, first published in 1979 and now on its 8th edition. Beauchamp and Childress do not endorse the view that respect is morally owed to all patients; they write, “Obligations to respect autonomy do not extend to persons who…are immature, incapacitated, ignorant, coerced, exploited, or the like… drug- dependent patients are examples.” Our parent study provides a unique opportunity to holistically explore clinician, patient, and bioethicist perspectives on the principle of respect for persons. Our overall goal is to provide clinicians with a rich conception of respect for patients as persons that can guide clinical practice, informed by those who are marginalized. Our specific aims are (AIM 1) To qualitatively explore the moral beliefs, values, and reasoning of 30 patients about the nature of respect in response to different categories of stigmatizing language found in medical records. Patients most at risk of being disrespected in healthcare will be oversampled. (AIM 2) To qualitatively explore the moral beliefs, values, and reasoning of 30 clinicians about the nature of respect in response to different categories of stigmatizing language found in medical records. Clinicians will be selected to maximize variability across age, gender, and specialty, while oversampling those who are underrepresented in the health professions. (AIM 3) To convene an expert panel of bioethicists to review the patient and clinician perspectives elicited in Aims 1 and 2, in the context of other related texts, and to apply the framework of reflective equilibrium in the formulation of a robust conception of the moral obligation to respect patients as persons. This supplemental ethics proposal aims to address both priorities of the NIH Office of Science Policy (research on bioethical issues that may inform future policy directions, and capacity-building in bioethics), and specifically addresses a form of structural racism that exists within the bioethics community, one which consistently and silently undermines our efforts to mitigate inequities in healthcare.

抽象的 在我们的医疗保健系统中，患者未接受同样的治疗。来自边缘化的种族/族裔的人，年龄较大 成人和健康素养低，肥胖，镰状细胞疾病和药物使用障碍的人通常是 卫生专业人员对其医疗保健质量产生不利影响的方式进行负面看法。而很多 造成这种差异的原因，临床医生对患者的偏见是一个重要因素。总体 父母研究的目标是提高不尊重和/或不尊重的人的护理质量和平等性 在医疗保健中受到污名。父母研究的具体目的是（1）开发一种污名化语言的分类法 在医疗记录中，（2）测量和测试这种语言的偏见，以及（3）减少其使用。中央 这一补充提议的前提是，这种对患者的尊重不足，以及由此产生的污名化 在他们的病历中出现的语言是由一组生物伦理和专业的人准备的 未能充分描述道德义务临床医生必须尊重患者的规范。几乎是 半个世纪，卫生专业人员的道德教育一直由Beauchamp和Childress's主导 生物医学伦理原则，最初于1979年出版，现在是第8版。 Beauchamp和Childress做 不认可尊重在道德上归功于所有患者的观点；他们写道：“尊重自治的义务确实 不扩展到……不成熟，丧失能力，无知，强迫，探索或类似的人……毒品 - 依赖患者就是例子。”我们的父母研究提供了一个独特的机会来整体探索 临床医生，患者和生物伦理学的观点对尊重人的原则。我们的总体目标是提供 临床医生对患者的尊重概念丰富，作为可以指导临床实践的人， 那些被边缘化的人。我们的具体目的是（目标1）定性地探索道德信念，价值观和 30名患者的尊重性质，以应对不同类别的污名化语言的性质 在病历中发现。在医疗保健中受到尊重的最大风险将被过采样。 （目标2） 定性地探索30位临床医生关于尊重本质的道德信念，价值观和推理 对医疗记录中发现的不同类别的污名语言的反应。临床医生将被选为 最大化年龄，性别和专业的变异性，同时对那些人数不足的人过采样 卫生专业。 （目标3）为了方便生物伦理学家的专家小组，以审查患者和临床 在其他相关文本的背景下，在目标1和2中引起的观点，并应用反思的框架 尊重患者作为人的道德目标概念的公式的平衡。这 补充道德建议旨在解决NIH科学政策办公室的两个优先事项（有关 生物伦理问题可能会为未来的政策指示和生物伦理学的能力建设提供信息），特别是 解决生物伦理学社区中存在的结构性种族主义形式，这种种族主义始终如一地 默默地破坏了我们减轻医疗保健不平等现象的努力。