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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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Velazquez AI, Gilligan TD, Kiel LL, Graff J, Duma N. Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do? Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35649205 DOI: 10.1200/edbk_350691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.
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Affiliation(s)
- Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Julie Graff
- Veterans Affairs Portland Health Care System, Portland, OR
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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Kanjee Z, Achebe MO, Smith WR, Burns RB. How Would You Treat This Patient With Acute and Chronic Pain From Sickle Cell Disease? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2022; 175:566-573. [PMID: 35404671 DOI: 10.7326/m22-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sickle cell disease is prevalent in large numbers of patients in the United States and has a significant global impact. Its complications span numerous organs and lead to reduced life expectancy. Acute and chronic sickle cell pain is a common cause of patient suffering. The American Society of Hematology published updated guidelines on management of acute and chronic pain from sickle cell disease in 2019. Several of the recommendations are conditional and leave specific decisions to the treating physician. These include conditional recommendations about the use of ketamine for acute pain and the initiation and discontinuation of long-term opioid therapy for chronic pain. Here, 2 hematologists discuss these guidelines and make contrasting recommendations for the management of acute and chronic pain for a patient with sickle cell disease.
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Affiliation(s)
- Zahir Kanjee
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Z.K., R.B.B.)
| | - Maureen Okam Achebe
- Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (M.O.A.)
| | - Wally R Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia (W.R.S.)
| | - Risa B Burns
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Z.K., R.B.B.)
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104
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Tucker Edmonds B, Schmidt A, Walker VP. Addressing bias and disparities in periviable counseling and care. Semin Perinatol 2022; 46:151524. [PMID: 34836664 DOI: 10.1016/j.semperi.2021.151524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Addressing bias and disparities in counseling and care requires that we contend with dehumanizing attitudes, stereotypes, and beliefs that our society and profession holds towards people of color, broadly, and Black birthing people in particular. It also necessitates an accounting of the historically informed, racist ideologies that shape present-day implicit biases. These biases operate in a distinctly complex and damaging manner in the context of end-of-life care, which centers around questions related to human pain, suffering, and value. Therefore, this paper aims to trace biases and disparities that operate in periviable care, where end-of-life decisions are made at the very beginning of life. We start from a historical context to situate racist ideologies into present day stereotypes and tropes that dehumanize and disadvantage Black birthing people and Black neonates in perinatal care. Here, we review the literature, address historical incidents and consider their impact on our ability to deliver patient-centered periviable care.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Associate Professor of Obstetrics and Gynecology & Vice Chair for Faculty Development and Diversity, Department of Obstetrics and Gynecology; Assistant Dean for Diversity Affairs, Indiana University School of Medicine, Indianapolis, IN.
| | | | - Valencia P Walker
- Associate Chief Diversity & Health Equity Officer, Nationwide Children's Hospital; Associate Division Chief for Health Equity & Inclusion, Department of Pediatrics, Division of Neonatology, The Ohio State University College of Medicine
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105
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Kronfli D, Savla B, Lievers A, Baker K, Eggleston C, Miller R, Bentzen SM, Mohindra P, Vyfhuis MA. Identifying Psychosocial Needs of Cancer Patients Undergoing Curative Radiation Therapy in an Inner-City Academic Center to Address Racial Disparities. Int J Radiat Oncol Biol Phys 2022; 114:185-194. [DOI: 10.1016/j.ijrobp.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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106
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Mayden KD. Improving Health Equity: The Role of the Oncology Advanced Practitioner in Managing Implicit Bias. J Adv Pract Oncol 2022; 12:868-874. [PMID: 35295541 PMCID: PMC8631340 DOI: 10.6004/jadpro.2021.12.8.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Implicit bias (IB) is the involuntary activation of thoughts, feelings, attitudes, or stereotypes that exist outside of conscious awareness. Implicit bias develops early in life and research documents the existence of IB across health-care settings. Negative IB impacts patient-provider interactions, produces inferior patient outcomes, and contributes to health-care disparities. Oncology APs are subject to IB and should be aware of its potential impact on professional practice. This manuscript explores the concept of IB and reviews evidence examining the clinical impact of IB in the oncology setting. Strategies for identifying and mitigating IB are explored. Highlights include the use of the Implicit Association Test and emotional intelligence. Advanced practice implications are discussed and range from self-improvement to organizational transformation.
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107
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Pun PH, Svetkey LP, McNally B, Dupre ME. Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics. KIDNEY360 2022; 3:1021-1030. [PMID: 35845342 PMCID: PMC9255868 DOI: 10.34067/kid.0008092021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
Background Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared with White patients. We examined the role of dialysis facility resources and patient factors in the observed racial disparity in CPR receipt and automated external defibrillator application. Methods This was a retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival and Medicare Annual Dialysis Facility Report registries from 2013 to 2017. We identified patients experiencing cardiac arrests within US outpatient dialysis clinics via geolocation matching (N=1554). Differences in facility size, quality, staffing, and patient-related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were used to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients. Results Compared with White patients, Black cardiac arrest patients dialyzed in larger facilities (26 versus 21 dialysis stations; P<0.001), facilities with fewer registered nurses per station (0.29 versus 0.33; P<0.001), and facilities with lower quality scores (# citations 6.8 versus 6.3; P=0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41% versus 35%; P<0.001), HIV/hepatitis B, and Medicaid-enrolled patients (15% versus 11%; P<0.001). Even after accounting for these differences and other covariates, the racial disparity for CPR in Black versus White patients persisted (OR=0.45; 95% CI, 0.27 to 0.75). The racial disparity in CPR was greater among older patients compared with younger patients (interaction P=0.04). Conclusions The racial disparity in CPR delivery within dialysis clinics was not explained by differences in facility resources and quality. Reducing this disparity will require a multifaceted approach, including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.
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Affiliation(s)
- Patrick H. Pun
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina,Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura P. Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Matthew E. Dupre
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina,Department of Sociology, Duke University, Durham, North Carolina
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108
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Johnson TJ. Antiracism, Black Lives Matter, and Critical Race Theory: The ABCs of Promoting Racial Equity in Pediatric Practice. Pediatr Ann 2022; 51:e95-e106. [PMID: 35293809 DOI: 10.3928/19382359-20220217-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Police shootings of unarmed Black men, women, and children at the intersection of disparities in the setting of the coronavirus disease 2019 pandemic have resulted in a long overdue national awakening regarding race and racism in society. This article defines some of the key terms, providing a foundation to help promote equity in pediatric practice. Although no single article can result in full competency regarding such complex issues, it is meant to provide a foundation for pediatricians on a journey to deepen their knowledge and understanding toward a path to action. [Pediatr Ann. 2022;51(3):e95-e106.].
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109
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Lett E, Asabor E, Beltrán S, Cannon AM, Arah OA. Conceptualizing, Contextualizing, and Operationalizing Race in Quantitative Health Sciences Research. Ann Fam Med 2022; 20:157-163. [PMID: 35045967 PMCID: PMC8959750 DOI: 10.1370/afm.2792] [Citation(s) in RCA: 153] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023] Open
Abstract
Differences in health outcomes across racial groups are among the most commonly reported findings in health disparities research. Often, these studies do not explicitly connect observed disparities to mechanisms of systemic racism that drive adverse health outcomes among racialized and other marginalized groups in the United States. Without this connection, investigators inadvertently support harmful narratives of biologic essentialism or cultural inferiority that pathologize racial identities and inhibit health equity. This paper outlines pitfalls in the conceptualization, contextualization, and operationalization of race in quantitative population health research and provides recommendations on how to appropriately engage in scientific inquiry aimed at understanding racial health inequities. Race should not be used as a measure of biologic difference, but rather as a proxy for exposure to systemic racism. Future studies should go beyond this proxy use and directly measure racism and its health impacts.VISUAL ABSTRACTAppeared as Annals "Online First" article.
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Affiliation(s)
- Elle Lett
- Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Applied Transgender Studies, Chicago, Illinois
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emmanuella Asabor
- Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, Pennsylvania
- Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut
| | - Sourik Beltrán
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Department of Statistics, University of California, Los Angeles College of Letters and Science, Los Angeles, California
- Department of Public Health, Aarhus University, Aarhus, Denmark
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110
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Bukstein DA, Friedman A, Gonzalez Reyes E, Hart M, Jones BL, Winders T. Impact of Social Determinants on the Burden of Asthma and Eczema: Results from a US Patient Survey. Adv Ther 2022; 39:1341-1358. [PMID: 35072886 PMCID: PMC8784588 DOI: 10.1007/s12325-021-02021-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
Introduction Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with asthma and/or eczema regarding disease and treatment burden and barriers to adequate care. Methods An online survey was completed by market research panelists in the USA between March 24, 2020 and April 6, 2020. Eligible participants were at least 18 years of age and endorsed a diagnosis of asthma and/or eczema. Survey responses are described for all participants, by designated racial/ethnic groups, and by income level. Results In all, 841 participants completed the survey (asthma, n = 554; eczema, n = 398; both, n = 111; White, n = 421; Black, n = 252; Hispanic, n = 95; low income [less than $15,000/year], n = 99; higher income [at least $15,000/year], n = 713). More Black and Hispanic participants than White participants, and more participants with low income than higher income, endorsed health literacy as a barrier (e.g., filling out official documents, understanding written materials). Participants with low income were less likely than participants with higher income to have an asthma action plan (42% vs 53%, respectively) and to discuss asthma control with their healthcare provider (54% vs 69%). Black and Hispanic participants were more likely than White participants to have an emergency department visit (52% and 49% vs 31%, respectively) or hospitalization (31% and 39% vs 16%) for asthma within the last 12 months. Participants reporting low income indicated that they experienced eczema symptoms more frequently than participants with higher income; 35% of low-income participants vs 15% of higher-income participants reported that they had not tried any eczema treatments. Participants in all racial/ethnic and income-level groups reported that their asthma or eczema impacted their lifestyle and daily activities. Conclusion More effective and culturally informed communication and education strategies to improve health information uptake and shared decision-making are needed to reduce the burdens of disease and treatment in highly impacted populations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02021-0. Disparities in asthma and eczema outcomes have been described in various populations. However, little is known about how these patient populations perceive their disease management or disease burden. A survey of 841 adults across diverse demographic groups in the USA with asthma and/or eczema was conducted to evaluate overall perceived disease burden and to specifically understand burden experiences by marginalized populations. In general, all participants indicated that asthma and eczema have a negative physical, emotional, and social impact on their lives. Some participants who identified as Black or Hispanic, and those with low income (less than $15,000/year), indicated greater difficulties in filling out paperwork or understanding written materials related to their condition than White participants or those with higher incomes. Black and Hispanic participants tended to receive asthma care in the emergency department or urgent care more than White participants and had more emergency department visits and hospitalizations than White Participants. Participants with low income were less likely to discuss their asthma management with their doctor than those with higher incomes and also indicated potential undertreatment of eczema. These results indicate that Black, Hispanic, or low-income patients may experience barriers to health equity. These barriers include lack of effective communication methods and materials to meet the needs of all patients, as well as the overall lack of quality healthcare access. These challenges must be addressed to overcome social disparities in health.
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Affiliation(s)
| | - Adam Friedman
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Erika Gonzalez Reyes
- Department of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Mary Hart
- Allergy & Asthma Network, Vienna, VA, USA
| | - Bridgette L Jones
- Children's Mercy Kansas City & University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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111
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van Andel CEE, Born MP, van den Broek WW, Stegers‐Jager KM. Do norms unintentionally increase stereotypical expressions? A randomised controlled trial. MEDICAL EDUCATION 2022; 56:331-338. [PMID: 34894161 PMCID: PMC9304281 DOI: 10.1111/medu.14712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Implicit biases of health professionals could cause biased judgements. Many anti-bias interventions seem to be ineffective, and some even counterproductive. People tend to be compliant to standards describing what the majority of people finds or does, and this could cause people to think in a stereotype-consistent manner. This study examines whether descriptive social norms such as 'the majority of people have stereotypes' (majority message), as often stated in interventions, actually increase people's stereotypes. To examine the effect of descriptive social norms (Hypothesis 1) and the effect of individual perceptions and preferences (Hypothesis 2a and 2b) on stereotypical expressions towards medical students. METHODS First, we determined which ethic stereotypes regarding medical students prevail in Dutch medical education (N = 52). Next, two similar randomised controlled trials, both with teachers and students, were carried out (N = 158 and N = 123, respectively), one with an East Asian student picture (ethnic minority) and one with a native Dutch student picture (ethnic majority). Participants were randomly assigned to either a majority-message, minority-message or no-message condition, and rated the presented minority or majority picture on specific stereotypical features. Subsequently, participants described a typical day of that same student's life. These descriptions were rated for stereotypicality by two independent raters, who were blind for condition and stimulus. Inclusive work environment (IWC) and social dominance orientation (SDO) of participants were measured as indicators of individual perceptions and preferences. RESULTS Stereotypes were expressed towards both picture stimuli, yet message condition did not affect stereotypical expressions. SDO positively related to stereotypical expressions towards the East Asian student, whereas IWC positively related to stereotypical expressions towards the native Dutch student. CONCLUSION Interventions do not unintentionally increase stereotypes by communicating what the majority of people thinks or does. Individual perceptions and preferences are predictive of stereotypes, whereas descriptive social norms are not.
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Affiliation(s)
| | - Marise P. Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
- Optentia and Faculty of Economic and Management SciencesNorth‐West UniversityPotchefstroomSouth Africa
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Gutman CK, Holmes S, Balhara KS. Low-value care in pediatric populations: There is no silver lining. Acad Emerg Med 2022; 29:804-807. [PMID: 35212441 DOI: 10.1111/acem.14470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Colleen K. Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - Sherita Holmes
- Department of Pediatrics Emory University School of Medicine Atlanta Georgia USA
- Division of Emergency Medicine Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
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113
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Li J, Ramgopal S, Marin JR. Racial and ethnic differences in low-value pediatric emergency care. Acad Emerg Med 2022; 29:698-709. [PMID: 35212440 DOI: 10.1111/acem.14468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Disparities in health care quality frequently focus on underuse. We evaluated racial/ethnic differences in low-value services delivered in the pediatric emergency department (ED). METHODS We performed a retrospective cross-sectional study of low-value services in children discharged from 39 pediatric EDs from January 2018 to December 2019 using the Pediatric Hospital Information System. Our primary outcome was receipt of one of 12 low-value services across nine conditions, including chest radiography in asthma and bronchiolitis; beta-agonist and corticosteroids in bronchiolitis; laboratory testing and neuroimaging in febrile seizure; neuroimaging in afebrile seizure; head injury and headache; and any imaging in sinusitis, constipation, and facial trauma. We analyzed the association of race/ethnicity on receipt of low-value services using generalized linear mixed models adjusted for age, sex, weekend, hour of presentation, payment, year, household income, and distance from hospital. RESULTS We included 4,676,802 patients. Compared with non-Hispanic White (NHW) patients, non-Hispanic Black (NHB) and Hispanic patients had lower adjusted odds (aOR [95% confidence interval]) of receiving imaging for asthma (0.60 [0.56 to 0.63] NHB; 0.84 [0.79 to 0.89] Hispanic), bronchiolitis (0.84 [0.79 to 0.89] NHB; 0.93 [0.88 to 0.99] Hispanic), head injury (0.84 [0.80 to 0.88] NHB; 0.80 [0.76 to 0.84] Hispanic), headache (0.67 [0.63 to 0.72] NHB; 0.83 [0.78 to 0.88] Hispanic), and constipation (0.71 [0.67 to 0.74] NHB; 0.76 [0.72 to 0.80] Hispanic). NHB patients had lower odds (95% CI) of receiving imaging for afebrile seizures (0.89 [0.8 to 1.0]) and facial trauma (0.69 [0.60 to 0.80]). Hispanic patients had lower odds (95% CI) of imaging (0.57 [0.36 to 0.90]) and blood testing (0.82 [0.69 to 0.98]) for febrile seizures. NHB patients had higher odds (95% CI) of receiving steroids (1.11 [1.00 to 1.21]) and beta-agonists (1.38 [1.24 to 1.54]) for bronchiolitis compared with NHW patients. CONCLUSIONS NHW patients more frequently receive low-value imaging while NHB patients more frequently receive low-value medications for bronchiolitis. Our study demonstrates the differences in care across race and ethnicity extend to many services, including those of low value. These findings highlight the importance of greater understanding of the complex interaction of race and ethnicity with clinical practice.
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Affiliation(s)
- Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Jennifer R. Marin
- Division of Pediatric Emergency Medicine UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
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114
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Azria E, Sauvegrain P, Anselem O, Bonnet MP, Deneux-Tharaux C, Rousseau A, Richetin J. Implicit biases and differential perinatal care for migrant women: methodological framework and study protocol of the BiP study part 3. J Gynecol Obstet Hum Reprod 2022; 51:102340. [PMID: 35181544 DOI: 10.1016/j.jogoh.2022.102340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The mechanisms of disparities in maternal and perinatal health between migrant and native women are multiple and remain poorly understood. Access to and quality of care are likely to participate in these mechanisms, and one hypothesis is the existence of implicit biases among caregivers through which ethno-racial belonging can influence medical decisions and consequently engender healthcare disparities. Their existence and their role in the generation of non-medically justified differential care have been documented in the United States apart from perinatal care, but remain largely unexplored in Europe. In this article, we present the study protocol and theoretical framework of a study that aims to test and quantify the existence of implicit bias toward African Sub-Saharan migrant women among caregivers working in the perinatal field, and to explore the association between implicit bias and differential care. MATERIAL AND METHODS This study is based on an online survey to which French obstetricians, midwives, and anesthetists were invited to take part. The potential existence of implicit biases toward African Sub-Saharan migrant will be quantified through a validated tool, the Implicit Association Test. Then we will assess how implicit biases are likely to influence clinical decisions and lead to differential care using clinical vignettes designed by an experts group. DISCUSSION Implicit bias and differential care are concept that are tricky to capture and interpret. This research program opens up in France a field of research on certain forms of health discriminations and sheds new light on the issue of social inequalities in perinatal health. STUDY REGISTRATION Registration in the Open Science Framework portal: https://osf.io/djva7/?view_only=c6012ace3fe94165a65b05c2dc6aff9e.
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Affiliation(s)
- Elie Azria
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France.
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, Maternity Unit, Groupe Hospitalier Pitié-Salpêtrière, DMU Origyne, AP-HP, Paris, France
| | - Olivia Anselem
- Port-Royal Maternity Unit, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique Hôpitaux de Paris, Université Paris, FHU Prema, Paris, France
| | - Marie-Pierre Bonnet
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, Department of Anesthesia and Intensive Care, Armand Trousseau Hospital, DMU DREAM, GRC 29, AP-HP, Paris, France; SFAR Research Network
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Anne Rousseau
- Université Paris-Saclay, UVSQ, UFR S. Veil-Santé, CESP équipe Epidémiologie Clinique, Inserm U1018, 78180 Montigny le Bretonneux; Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, F-78300 Poissy, France
| | - Juliette Richetin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.; Bicocca center for Applied Psychology, University of Milano Bicocca, Milan, Italy
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Valentine KD, Scherer LD. Interpersonal (mis)perceptions and (mis)predictions in patient-clinician interactions. Curr Opin Psychol 2022; 43:244-248. [PMID: 34461604 PMCID: PMC8801540 DOI: 10.1016/j.copsyc.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
Patient-clinician interactions require an interpersonal exchange of information, preferences, expectations, values, and priorities. Given the brief interaction patients and clinicians are allowed, many barriers to effective communication exist, resulting in patients and clinicians leaving an interaction with discordant perceptions of what has occurred and what is to come. We review literature on concordance and lack thereof, between patient and clinician perceptions, reasons why discordance may occur, how to decrease discordance as well as how dischordance impacts patient care and outcomes.
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Affiliation(s)
- KD Valentine
- Massachusetts General Hospital,Harvard Medical School
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Johnson TJ, Goyal MK, Lorch SA, Chamberlain JM, Bajaj L, Alessandrini EA, Simmons T, Casper TC, Olsen CS, Grundmeier RW, Alpern ER. Racial/Ethnic Differences in Pediatric Emergency Department Wait Times. Pediatr Emerg Care 2022; 38:e929-e935. [PMID: 34140453 PMCID: PMC8671570 DOI: 10.1097/pec.0000000000002483] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Wait time for emergency care is a quality measure that affects clinical outcomes and patient satisfaction. It is unknown if there is racial/ethnic variability in this quality measure in pediatric emergency departments (PEDs). We aim to determine whether racial/ethnic differences exist in wait times for children presenting to PEDs and examine between-site and within-site differences. METHODS We conducted a retrospective cohort study for PED encounters in 2016 using the Pediatric Emergency Care Applied Research Network Registry, an aggregated deidentified electronic health registry comprising 7 PEDs. Patient encounters were included among all patients 18 years or younger at the time of the ED visit. We evaluated differences in emergency department wait time (time from arrival to first medical evaluation) considering patient race/ethnicity as the exposure. RESULTS Of 448,563 visits, median wait time was 35 minutes (interquartile range, 17-71 minutes). Compared with non-Hispanic White (NHW) children, non-Hispanic Black (NHB), Hispanic, and other race children waited 27%, 33%, and 12% longer, respectively. These differences were attenuated after adjusting for triage acuity level, mode of arrival, sex, age, insurance, time of day, and month [adjusted median wait time ratios (95% confidence intervals): 1.11 (1.10-1.12) for NHB, 1.12 (1.11-1.13) for Hispanic, and 1.05 (1.03-1.06) for other race children compared with NHW children]. Differences in wait time for NHB and other race children were no longer significant after adjusting for clinical site. Fully adjusted median wait times among Hispanic children were longer compared with NHW children [1.04 (1.03-1.05)]. CONCLUSIONS In unadjusted analyses, non-White children experienced longer PED wait times than NHW children. After adjusting for illness severity, patient demographics, and overcrowding measures, wait times for NHB and other race children were largely determined by site of care. Hispanic children experienced longer within-site and between-site wait times compared with NHW children. Additional research is needed to understand structures and processes of care contributing to wait time differences between sites that disproportionately impact non-White patients.
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Affiliation(s)
- Tiffani J Johnson
- From the University of California, Davis Medical Center, Sacramento, CA
| | - Monika K Goyal
- Children's National Health System, The George Washington University, Washington, DC
| | - Scott A Lorch
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - James M Chamberlain
- Children's National Health System, The George Washington University, Washington, DC
| | - Lalit Bajaj
- University of Colorado, Children's Hospital, Aurora, CO
| | | | | | | | | | - Robert W Grundmeier
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth R Alpern
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
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117
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Smith DT, Faber SC, Buchanan NT, Foster D, Green L. The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision. Front Psychiatry 2022; 12:774736. [PMID: 35126196 PMCID: PMC8811257 DOI: 10.3389/fpsyt.2021.774736] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Psychedelic medicine is an emerging field that examines entheogens, psychoactive substances that produce non-ordinary states of consciousness (NOSC). 3,4-methylenedioxymethamphetamine (MDMA) is currently in phase-3 FDA clinical trials in the United States (US) and Canada to treat the symptoms of posttraumatic stress disorder (PTSD). MDMA is used in conjunction with manualized therapy, because of its effectiveness in reducing fear-driven stimuli that contribute to trauma and anxiety symptoms. In 2017, the FDA designated MDMA as a "breakthrough therapy," signaling that it has advantages in safety, efficacy, and compliance over available medication for the treatment of trauma-, stress-, and anxiety-related disorders such as PTSD. In the US and Canada, historical and contemporary racial mistreatment is frequently experienced by Black people via a variety of macro and micro insults. Such experiences trigger physiological responses of anxiety and fear, which are associated with chronically elevated stress hormone levels (e.g., cortisol and epinephrine), similar to levels documented among those diagnosed with an anxiety disorder. This paper will explore the benefits of entheogens within psychedelic assisted-therapy and their potential benefits in addressing the sequelae of pervasive and frequent negative race-based experiences and promoting healing and thriving among Black, Indigenous and other People of Color (BIPOC). The author(s) discuss the ethical responsibility for providing psychedelic-assisted therapy within a culturally competent provider framework and the importance of psychedelic researchers to recruit and retain BIPOC populations in research and clinical training.
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Affiliation(s)
- Darron T. Smith
- Department of Sociology, The University of Memphis, Memphis, TN, United States
| | | | - NiCole T. Buchanan
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Lilith Green
- Department of Sociology, The University of Memphis, Memphis, TN, United States
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Vela MB, Erondu AI, Smith NA, Peek ME, Woodruff JN, Chin MH. Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annu Rev Public Health 2022; 43:477-501. [PMID: 35020445 PMCID: PMC9172268 DOI: 10.1146/annurev-publhealth-052620-103528] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.
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Affiliation(s)
- Monica B Vela
- Department of Medicine, Section of Academic Internal Medicine, University of Illinois College of Medicine in Chicago, Chicago, Illinois, USA;
| | - Amarachi I Erondu
- Department of Internal Medicine and Pediatrics, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nichole A Smith
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E Peek
- Department of Medicine, Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
| | - James N Woodruff
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
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119
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Implicit biases in healthcare: implications and future directions for gynecologic oncology. Am J Obstet Gynecol 2022; 227:1-9. [PMID: 35026128 DOI: 10.1016/j.ajog.2021.12.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
Abstract
Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.
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120
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Liu FF, Coifman J, McRee E, Stone J, Law A, Gaias L, Reyes R, Lai CK, Blair IV, Yu CL, Cook H, Lyon AR. A Brief Online Implicit Bias Intervention for School Mental Health Clinicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:679. [PMID: 35055506 PMCID: PMC8776032 DOI: 10.3390/ijerph19020679] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
Clinician bias has been identified as a potential contributor to persistent healthcare disparities across many medical specialties and service settings. Few studies have examined strategies to reduce clinician bias, especially in mental healthcare, despite decades of research evidencing service and outcome disparities in adult and pediatric populations. This manuscript describes an intervention development study and a pilot feasibility trial of the Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for mental health clinicians in schools-where most youth in the U.S. access mental healthcare. Clinicians (N = 12) in the feasibility study-a non-randomized open trial-rated VIBRANT as highly usable, appropriate, acceptable, and feasible for their school-based practice. Preliminarily, clinicians appeared to demonstrate improvements in implicit bias knowledge, use of bias-management strategies, and implicit biases (as measured by the Implicit Association Test [IAT]) post-training. Moreover, putative mediators (e.g., clinicians' VIBRANT strategies use, IAT D scores) and outcome variables (e.g., clinician-rated quality of rapport) generally demonstrated correlations in the expected directions. These pilot results suggest that brief and highly scalable online interventions such as VIBRANT are feasible and promising for addressing implicit bias among healthcare providers (e.g., mental health clinicians) and can have potential downstream impacts on minoritized youth's care experience.
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Affiliation(s)
- Freda F. Liu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Jessica Coifman
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Erin McRee
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Jeff Stone
- Department of Psychology, University of Arizona, 1503 E University Blvd. Building 68, Tucson, AZ 85721, USA;
| | - Amy Law
- Learning Gateway, University of Washington School of Medicine, 850 Republican St., Bldg. C-4, Seattle, WA 98109, USA;
| | - Larissa Gaias
- Department of Psychology, University of Massachusetts, Lowell, 850 Broadway Street, Lowell, MA 01854, USA;
| | - Rosemary Reyes
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Calvin K. Lai
- Department of Psychological and Brain Sciences, Washington University in St. Louis, CB 1125, One Brookings Drive, St. Louis, MO 63130, USA;
| | - Irene V. Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO 80309, USA;
| | - Chia-li Yu
- Department of Psychology, Pennsylvania State University, 140 Moore Building, University Park, State College, PA 16802, USA;
| | - Heather Cook
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
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Penn JA, Newman-Griffis D. Half the picture: Word frequencies reveal racial differences in clinical documentation, but not their causes. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2022:386-395. [PMID: 35854748 PMCID: PMC9285139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Clinical notes are the best record of a provider's perceptions of their patients, but their use in studying racial bias in clinical documentation has typically been limited to manual evaluation of small datasets. We investigated the use of computational methods to scale these insights to large, heterogeneous clinical text data. We found significant differences in negative emotional tone and language implying social dominance in clinical notes between Black and White patients, but identified multiple contributing factors in addition to potential provider bias, including mis-categorization of some healthcare vocabulary as emotion-related. We further found that notes for Black patients were significantly less likely to mention opioids than for White patients, potentially reflecting both inequitable access to medication and provider bias. Our analysis showed that computational tools have significant potential for studying racial bias in large clinical corpora, and identified key challenges to providing a nuanced analysis of bias in clinical documentation.
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Mahdavinia M, Bilaver LA, Fox S, Pappalardo AA, Andy-Nweye AB, Sharma HP, Assa’ad AH, Gupta RS, Tobin MC. Racial disparity in treatment of gastroesophageal reflux disease in children with food allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:339-342.e2. [PMID: 34678499 PMCID: PMC8748421 DOI: 10.1016/j.jaip.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Mahboobeh Mahdavinia
- Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Ill
| | - Lucy A Bilaver
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Susan Fox
- Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Ill
| | - Andrea A Pappalardo
- University of Illinois at Chicago, Department of Medicine and Pediatrics, Chicago, Ill
| | - Aame B Andy-Nweye
- Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Ill
| | - Hemant P. Sharma
- Division of Allergy and Immunology, Children’s National Health Systems, Washington, DC
| | - Amal H. Assa’ad
- Division of Allergy & Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Ruchi S. Gupta
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill,Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Ill
| | - Mary C. Tobin
- Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Ill
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Santee J, Barnes K, Borja-Hart N, Cheng AL, Draime J, Edwards A, Nonyel N, Sawkin M. Correlation Between Pharmacy Students' Implicit Bias Scores, Explicit Bias Scores, and Responses to Clinical Cases. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8587. [PMID: 34301558 PMCID: PMC8787177 DOI: 10.5688/ajpe8587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
Objective. The purpose of this study was to identify the extent of implicit and explicit bias in a sample of pharmacy students and to determine whether there is an association between implicit bias, explicit bias, and responses to clinical cases.Methods. Investigators sent links to two online surveys to students at six US schools and colleges of pharmacy. In the first survey, students responded to two clinical cases. Students were presented with a picture of a White or Black patient with each clinical case. On the second survey, students indicated their level of racial implicit bias as assessed by the Harvard Implicit Association Test and their level of racial explicit bias. Pearson's correlation was used to determine the correlation between bias and responses to the clinical cases.Results. Three hundred fifty-seven first, second, and third year pharmacy students responded to both surveys (response rate 52%). The students who were presented with the picture of a Black patient rated the patient's pain and the reliability of the patient's family as higher than students presented with the picture of a White patient. Students had more negative implicit and explicit bias towards Black patients. Neither implicit nor explicit bias correlated with student responses to the clinical cases.Conclusion. Evidence of slight to moderate negative implicit bias and slight negative explicit bias towards Black patients was identified in this group of pharmacy students. Future studies that include a more representative population and heighten the stakes of the clinical scenario should be done to investigate a possible correlation between bias and clinical behaviors.
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Affiliation(s)
- Jennifer Santee
- University of Missouri - Kansas City, School of Pharmacy, Kansas City, Missouri
| | - Kylie Barnes
- University of Missouri - Kansas City, School of Pharmacy, Kansas City, Missouri
| | - Nancy Borja-Hart
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - An-Lin Cheng
- University of Missouri - Kansas City, School of Medicine, Kansas City, Missouri
| | - Juanita Draime
- Cedarville University, School of Pharmacy, Cedarville, Ohio
| | - Akesha Edwards
- University of Findlay, College of Pharmacy, Findlay, Ohio
| | - Nkem Nonyel
- University of Maryland Eastern Shore, School of Pharmacy, Princess Anne, Maryland
| | - Mark Sawkin
- University of Missouri - Kansas City, School of Pharmacy, Kansas City, Missouri
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Connelly M, Glynn EF, Hoffman MA, Bickel J. Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults. Pediatr Emerg Care 2021; 37:e981-e987. [PMID: 31246788 DOI: 10.1097/pec.0000000000001851] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings. METHODS Data from 2010 to 2016 in the Cerner Health Facts electronic health record data warehouse were analyzed using multilevel logistic regression to estimate the population likelihood of an opioid being used in the emergency department (ED) to treat a primary diagnosis of migraine in adolescents and young adults and to evaluate the extent to which this likelihood varies as a function of characteristics of the patient (age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration and year), and ED (region, setting, size, payer mix, and academic status). RESULTS The study identified 14,494 eligible ED encounters with unique patients, of which 23% involved an opioid. Likelihood of being treated with opioids was significantly higher for patients who were older, female, white, and seen by a surgeon and who had longer encounters and encounters earlier in the time period sampled. Sites varied widely in percentage of encounters involving opioids (mean, 26.4% ± 20.1%; range, 0-100%), with higher rates associated with smaller sites with relatively higher proportions of commercially insured patients. CONCLUSIONS Use of opioids in the ED to treat migraine in youth is fairly common, with rate variation reflecting broader trends in for whom opioids tend to be more likely to be prescribed. These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth.
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Affiliation(s)
- Mark Connelly
- From the Children's Mercy Kansas City, Kansas City, MO
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Thomasian NM, Eickhoff C, Adashi EY. Advancing health equity with artificial intelligence. J Public Health Policy 2021; 42:602-611. [PMID: 34811466 PMCID: PMC8607970 DOI: 10.1057/s41271-021-00319-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 12/17/2022]
Abstract
Population and public health are in the midst of an artificial intelligence revolution capable of radically altering existing models of care delivery and practice. Just as AI seeks to mirror human cognition through its data-driven analytics, it can also reflect the biases present in our collective conscience. In this Viewpoint, we use past and counterfactual examples to illustrate the sequelae of unmitigated bias in healthcare artificial intelligence. Past examples indicate that if the benefits of emerging AI technologies are to be realized, consensus around the regulation of algorithmic bias at the policy level is needed to ensure their ethical integration into the health system. This paper puts forth regulatory strategies for uprooting bias in healthcare AI that can inform ongoing efforts to establish a framework for federal oversight. We highlight three overarching oversight principles in bias mitigation that maps to each phase of the algorithm life cycle.
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Affiliation(s)
- Nicole M Thomasian
- Warren Alpert Medical School of Brown University, Brown University, 222 Richmond Street, Providence, RI, 02906, USA.
- The Harvard Kennedy School of Government, Harvard University, Cambridge, MA, USA.
| | - Carsten Eickhoff
- Center for Biomedical Informatics, Brown University, Providence, RI, USA
- Department of Computer Science, Brown University, Providence, RI, USA
| | - Eli Y Adashi
- Warren Alpert Medical School of Brown University, Brown University, 222 Richmond Street, Providence, RI, 02906, USA
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Stewart BA, Stewart JH. Disparities in Clinical Trial Participation: Multilevel Opportunities for Improvement. Surg Oncol Clin N Am 2021; 31:55-64. [PMID: 34776064 DOI: 10.1016/j.soc.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Current data demonstrate ongoing inequities in surgical oncology clinical trials and understanding these disparities is vital to creating a more just and equitable health care system. Analysis of participatory patterns in cooperative group surgical oncology trials demonstrates complex relationships between race, socioeconomic status, and participation in these trials at the patient level. Further analysis reveals that provider-level implicit bias plays a significant role in access to clinical trials by minority populations. Holistic approaches to addressing disparities in clinical trial participation include creating a more robust pipeline of minority surgeon-scientists, engaging in partnerships with community advocates, and promoting public policy.
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Affiliation(s)
- Brooke A Stewart
- Department of Psychology, Appalachian State University, Boone, NC, USA
| | - John H Stewart
- Louisiana State University, New Orleans School of Medicine; Louisiana State University New Orleans- Louisiana Children's Medical Center Cancer Center, New Orleans, Louisiana, USA.
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127
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Burkhardt J, DesJardins S, Gruppen L. Diversity of the physician workforce: Specialty choice decisions during medical school. PLoS One 2021; 16:e0259434. [PMID: 34735513 PMCID: PMC8568153 DOI: 10.1371/journal.pone.0259434] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics. Objectives To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students. Methods Secondary data analyses of all medical students who applied through ERAS from 2005–2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences. Results Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics. Conclusions From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students’ specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation.
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Affiliation(s)
- John Burkhardt
- Department of Emergency Medicine and Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Stephen DesJardins
- Center for the Study of Higher and Postsecondary Education at the University of Michigan School of Education and Gerald Ford School of Public Policy, Ann Arbor, Michigan, United States of America
| | - Larry Gruppen
- Department of Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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128
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Lloyd EP, Lloyd AR, McConnell AR, Hugenberg K. Race Deficits in Pain Detection: Medical Providers and Laypeople Fail to Accurately Perceive Pain Authenticity Among Black People. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2021. [DOI: 10.1177/19485506211045887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Across six studies ( N = 904), we suggest a novel mechanism for race disparities in pain treatment: Perceiver deficits in discriminating real from fake pain for Black (relative to White) individuals. Across Studies 1–4, White participants (Studies 1–4) and Black participants (Study 2) were better at discerning authentic from inauthentic pain expressions for White targets than for Black targets. This effect emerged for both subtle (Studies 1 and 2) and intense (Studies 3 and 4) pain stimuli. Studies 5 and 6 examined consequences for medical care decisions by examining pain treatment recommendations by laypeople (Study 5) and pain authenticity judgments by medical providers (Study 6). This work advances theory in pain perception, emotion judgment, and intergroup relations. It also has practical significance for identifying unexplored mechanisms causing racial disparities in medical care.
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Affiliation(s)
| | - Audrey R. Lloyd
- University of Alabama at Birmingham School of Medicine, AL, USA
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129
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Plancarte CA, Hametz P, Southern WN. Association Between English Proficiency and Timing of Analgesia Administration After Surgery. Hosp Pediatr 2021; 11:1199-1204. [PMID: 34654728 DOI: 10.1542/hpeds.2020-005766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pediatric patients from families with limited English proficiency (LEP) are at risk for health care disparities. We examined timeliness of analgesic administration in pediatric postoperative patients with a limb fracture from LEP versus non-LEP families. METHODS This was a retrospective cohort study of children aged 1 year to <18 years of age, hospitalized to the general inpatient floor after surgical correction of single limb fractures between July 2016 and July 2019 were eligible. Patients whose consent was in a non-English language or for whom an interpreter was used were classified as from LEP families. The primary outcome was time to first analgesia. Secondary outcomes included time to first opioid, proportion with any analgesia and opioid analgesia, and number of pain assessments. Associations between LEP and outcomes were tested by using χ2 tests, Kaplan-Meier plots, and Cox proportional hazards models. RESULTS We examined 306 patients, of whom 59 (19%) were from LEP families. Children in LEP families were significantly less likely to receive any analgesia (86.4% vs 96.8%, P ≤ .01) and experienced longer time to first analgesia in unadjusted (hazard ratio = 0.68, 95% confidence interval: 0.50-0.92) and adjusted analyses (hazard ratio = 0.68, 95% confidence interval: 0.50-0.94). There was no significant association between LEP and time to first opioid, proportion given opioid analgesia, or number of pain assessments. CONCLUSION Hospitalized children from LEP families experience a longer time to analgesia administration after surgery. The mechanisms that lead to these differences in care must be identified so that interventions can be designed to address them.
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Affiliation(s)
- Carlos A Plancarte
- Division of Pediatric Hospital Medicine .,Department of Pediatrics.,Monroe Carell Jr Children's Hospital at Vanderbilt
| | - Patricia Hametz
- Division of Pediatric Hospital Medicine.,Department of Pediatrics.,The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - William N Southern
- Division of Hospital Medicine.,Department of Medicine.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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130
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Making 'Good Trouble': Time for Organized Medicine to Call for Racial Justice in Medical Education and Health Care. Am J Med 2021; 134:1203-1209. [PMID: 34062146 DOI: 10.1016/j.amjmed.2021.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
"Never, ever be afraid to make some noise and get in good trouble, necessary trouble." - Representative John Lewis It is time now for organized medicine to make "good trouble" and call for racial justice in medical education and health care. It is also time to have an honest confrontation with reality in order to bring about racial healing and become anti-racist organizations. Using a racial justice framework, 4 elements described here can chart our course. Organized medicine must come together in solidarity to make "good trouble" and fight collectively for racial justice so that every community we serve can achieve their full health potential and achieve racial equity-that is, giving people what they need to enjoy full, healthy lives regardless of race.
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131
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Anastas TM, Miller MM, Hollingshead NA, Stewart JC, Rand KL, Hirsh AT. The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions. Ann Behav Med 2021; 54:771-782. [PMID: 32227158 DOI: 10.1093/abm/kaaa016] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES. PURPOSE We examined the effects of patient race and SES on providers' chronic pain decisions and the extent to which providers' implicit and explicit attitudes about race and SES were related to these decisions. METHODS Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES. RESULTS There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers' implicit and explicit attitudes predicted some, but not all, of their pain-related ratings. CONCLUSION These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care.
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Affiliation(s)
- Tracy M Anastas
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | - Megan M Miller
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | | | - Jesse C Stewart
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | - Kevin L Rand
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | - Adam T Hirsh
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
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132
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Glasofer A, Dingley C. Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review. J Racial Ethn Health Disparities 2021; 9:2027-2048. [PMID: 34520001 DOI: 10.1007/s40615-021-01142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.
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Affiliation(s)
- Amy Glasofer
- School of Nursing, University of Nevada, Las Vegas, NV, USA.
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133
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Hester G, Nickel AJ, Watson D, Bergmann KR. Factors Associated With Bronchiolitis Guideline Nonadherence at US Children's Hospitals. Hosp Pediatr 2021; 11:1102-1112. [PMID: 34493589 DOI: 10.1542/hpeds.2020-005785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective with this study was to explore factors associated with nonadherence to national bronchiolitis guidelines at 52 children's hospitals. METHODS We included patients 1 month to 2 years old with emergency department (ED) or admission encounters between January 2016 and December 2018 and bronchiolitis diagnoses in the Pediatric Health Information System database. We excluded patients with any intensive care, stay >7 days, encounters in the preceding 30 days, chronic medical conditions, croup, pneumonia, or asthma. Guideline nonadherence was defined as receiving any of 5 tests or treatments: bronchodilators, chest radiographs, systemic steroids, antibiotics, and viral testing. Nonadherence outcomes were modeled by using mixed effects logistic regression with random effects for providers and hospitals. Adjusted odds ratio (aOR) >1 indicates greater likelihood of nonadherence. RESULTS A total of 198 028 encounters were included (141 442 ED and 56 586 admission), and nonadherence was 46.1% (ED: 40.2%, admissions: 61.0%). Nonadherence increased with patient age, with both ED and hospital providers being more likely to order tests and treatments for children 12 to 24 months compared with infants 1 ot 2 months (ED: aOR, 3.39; 95% confidence interval [CI], 3.20-3.60; admissions: aOR, 2.97; CI, 2.79-3.17]). Admitted non-Hispanic Black patients were more likely than non-Hispanic white patients to receive guideline nonadherent care (aOR, 1.16; CI, 1.10-1.23), a difference driven by higher use of steroids (aOR, 1.29; CI, 1.17-1.41) and bronchodilators (aOR, 1.39; CI, 1.31-1.48). Hospital effects were prominent for viral testing in ED and admission encounters (intraclass correlation coefficient of 0.35 and 0.32, respectively). CONCLUSIONS Multiple factors are associated with national bronchiolitis guideline nonadherence.
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Affiliation(s)
| | | | | | - Kelly R Bergmann
- Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota
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134
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Ahadinezhad B, Khosravizadeh O, Maleki A, Hashtroodi A. Implicit racial bias among medical graduates and students by an IAT measure: a systematic review and meta-analysis. Ir J Med Sci 2021; 191:1941-1949. [PMID: 34495481 DOI: 10.1007/s11845-021-02756-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Racial implicit bias is an unconscious response and behavior that affects interpersonal interactions and clinical decision-making. AIMS We attempted to meta-analyze the scores of implicit association test (IAT) to estimate pooled quantity of implicit racial bias among medical graduates and students METHODS: As far as we know, our study is the first systematic-based meta-analysis estimating the pooled score of implicit racial bias among physicians and medical students. Keywords were searched in Scopus, Web of Science, Google Scholar, PubMed, Science Direct, Cochrane, MEDLINE, Wiley online library, and ProQuest databases from 2011 since 2021. The IAT's pooled score estimates through a fixed-effect meta-analysis using STATA 15. Also, I2 statistic was used to determine heterogeneity across the articles. RESULTS Out of 1177 articles, 29 studies entered to analysis. The pooled score of IAT among physicians and medical students was 0.28 (95% CI 0.13 to 0.43) and 0.35 (95% CI 0.03 to 0.67), respectively. The racial bias score of physician ranged from -0.12 to 0.62. While score of implicit association test for medical student ranged from -0.01 to 1.29. CONCLUSION Our meta-analysis revealed that there was an implicit anti-black attitude among physicians and medical students, but the size of this implicit racial bias was small. Although the level of racial bias in physicians and medical students was low, it could be reduced to the lowest level through informative programs and training in ways to control implicit attitudes.
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Affiliation(s)
- Bahman Ahadinezhad
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Aisa Maleki
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Ailar Hashtroodi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
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135
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Honcoop AC, Poitevien P, Kerns E, Alverson B, McCulloh RJ. Racial and ethnic disparities in bronchiolitis management in freestanding children's hospitals. Acad Emerg Med 2021; 28:1043-1050. [PMID: 33960050 DOI: 10.1111/acem.14274] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Variation in bronchiolitis management by race and ethnicity within emergency departments (EDs) has been described in single-center and prospective studies, but large-scale assessments across EDs and inpatient settings are lacking. Our objective is to describe the association between race and ethnicity and bronchiolitis management across 37 U.S. freestanding children's hospitals from 2015 to 2018. METHODS Using the Pediatric Health Information System, we analyzed ED and inpatient visits from November 2015 to November 2018 of children with bronchiolitis 3 to 24 months old. Rates of use for specific diagnostic tests and therapeutic measures were compared across the following race/ethnicity categories: 1) non-Hispanic White (NHW), 2) non-Hispanic Black (NHB), 3) Hispanic, and 4) other. The subanalyses of ED patients only and children < 1 year old were performed. Mixed-effect logistic regression was performed to compare the adjusted odds of receiving specific test/treatment using NHW children as the reference group. RESULTS A total of 134,487 patients met inclusion criteria (59% male, 28% NHB, 26% Hispanic). Adjusted analysis showed that NHB children had higher odds of receiving medication associated with asthma (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.22 to 1.32) and lower odds of receiving diagnostic tests (blood cultures, complete blood counts, viral testing, chest x-rays; OR = 0.78, 95% CI = 0.75 to 0.81) and antibiotics (OR = 0.58, 95% CI = 0.52 to 0.64) than NHW children. Hispanic children had lower odds of receiving diagnostic testing (OR = 0.94, 95% CI = 0.90 to 0.98), asthma-associated medication (OR = 0.92, 95% CI = 0.88 to 0.96), and antibiotics (OR = 0.74, 95% CI = 0.66 to 0.82) compared to NHW children. CONCLUSION NHB children more often receive corticosteroid and bronchodilator therapies; NHW children more often receive antibiotics and chest radiography. Given that current guidelines generally recommend supportive care with limited diagnostic testing and medical intervention, these findings among NHB and NHW children represent differing patterns of overtreatment. The underlying causes of these patterns require further investigation.
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Affiliation(s)
| | - Patricia Poitevien
- Hasbro Children's HospitalWarren Alpert Medical School Providence Rhode Island USA
| | - Ellen Kerns
- University of Nebraska Medical CenterChildren's Hospital Medical Center Omaha Nebraska USA
| | - Brian Alverson
- Hasbro Children's HospitalWarren Alpert Medical School Providence Rhode Island USA
| | - Russell J. McCulloh
- University of Nebraska Medical CenterChildren's Hospital Medical Center Omaha Nebraska USA
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136
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Addala A, Hanes S, Naranjo D, Maahs DM, Hood KK. Provider Implicit Bias Impacts Pediatric Type 1 Diabetes Technology Recommendations in the United States: Findings from The Gatekeeper Study. J Diabetes Sci Technol 2021; 15:1027-1033. [PMID: 33858206 PMCID: PMC8442183 DOI: 10.1177/19322968211006476] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes technology use is associated with favorable type 1 diabetes (T1D) outcomes. American youth with public insurance, a proxy for low socioeconomic status, use less diabetes technology than those with private insurance. We aimed to evaluate the role of insurance-mediated provider implicit bias, defined as the systematic discrimination of youth with public insurance, on diabetes technology recommendations for youth with T1D in the United States. METHODS Multi-disciplinary pediatric diabetes providers completed a bias assessment comprised of a clinical vignette and ranking exercises (n = 39). Provider bias was defined as providers: (1) recommending more technology for those on private insurance versus public insurance or (2) ranking insurance in the top 2 of 7 reasons to offer technology. Bias and provider characteristics were analyzed with descriptive statistics, group comparisons, and multivariate logistic regression. RESULTS The majority of providers [44.1 ± 10.0 years old, 83% female, 79% non-Hispanic white, 49% physician, 12.2 ± 10.0 practice-years] demonstrated bias (n = 33/39, 84.6%). Compared to the group without bias, the group with bias had practiced longer (13.4±10.4 years vs 5.7 ± 3.6 years, P = .003) but otherwise had similar characteristics including age (44.4 ± 10.2 vs 42.6 ± 10.1, p = 0.701). In the logistic regression, practice-years remained significant (OR = 1.47, 95% CI [1.02,2.13]; P = .007) when age, sex, race/ethnicity, provider role, percent public insurance served, and workplace location were included. CONCLUSIONS Provider bias to recommend technology based on insurance was common in our cohort and increased with years in practice. There are likely many reasons for this finding, including healthcare system drivers, yet as gatekeepers to diabetes technology, providers may be contributing to inequities in pediatric T1D in the United States.
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Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of
Endocrinology, Stanford University, Stanford, CA, USA
| | - Sarah Hanes
- Department of Pediatrics, Division of
Endocrinology, Stanford University, Stanford, CA, USA
| | - Diana Naranjo
- Department of Pediatrics, Division of
Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center,
Stanford, CA, USA
| | - David M. Maahs
- Department of Pediatrics, Division of
Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center,
Stanford, CA, USA
| | - Korey K. Hood
- Department of Pediatrics, Division of
Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center,
Stanford, CA, USA
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137
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Gallegos A, Dudovitz R, Biely C, Chung PJ, Coker TR, Barnert E, Guerrero AD, Szilagyi PG, Nelson BB. Racial Disparities in Developmental Delay Diagnosis and Services Received in Early Childhood. Acad Pediatr 2021; 21:1230-1238. [PMID: 34020100 PMCID: PMC9169674 DOI: 10.1016/j.acap.2021.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Racial disparities in diagnosis and receipt of services for early childhood developmental delay (DD) are well known but studies have had difficulties distinguishing contributing patient, healthcare system, and physician factors from underlying prevalence. We examine rates of physician diagnoses of DD by preschool and kindergarten entry controlling for a child's objective development via scoring on validated developmental assessment along with other child characteristics. METHODS We used data from the preschool and kindergarten entry waves of the Early Childhood Longitudinal Study, Birth Cohort. Dependent variables included being diagnosed with DD by a medical provider and receipt of developmental services. Logistic regression models tested whether a child's race was associated with both outcomes during preschool and kindergarten while controlling for the developmental assessments, as well as other contextual factors. RESULTS Among 7950 children, 6.6% of preschoolers and 7.5% of kindergarteners were diagnosed with DD. Of preschool children with DD, 66.5% were receiving developmental services, while 69.1% of kindergarten children with DD were receiving services. Children who were Black, Asian, spoke a primary language other than English and had no health insurance were less likely to be diagnosed with DD despite accounting for cognitive ability. Black and Latinx children were less likely to receive services. CONCLUSIONS Racial minority children are less likely to be diagnosed by their pediatric provider with DD and less likely to receive services despite accounting for a child's objective developmental assessment. The pediatric primary care system is an important target for interventions to reduce these disparities.
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Affiliation(s)
- Abraham Gallegos
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif; UCLA NRSA T32 Primary Care Research Fellowship, University of California, Los Angeles (A Gallegos, PG Szilagyi, PJ Chung), Calif.
| | - Rebecca Dudovitz
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif
| | - Christopher Biely
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif
| | - Paul J Chung
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif; Kaiser Permanente Bernard J. Tyson School of Medicine (PJ Chung), Pasadena, Calif; Department of Health Policy and Management, Fielding School of Public Health, University of California (PJ Chung), Los Angeles, Calif
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute (TR Coker), Seattle, Wash
| | - Elizabeth Barnert
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif
| | - Alma D Guerrero
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California (A Gallegos, R Dudovitz, C Biely, PJ Chung, E Barnert, AD Guerrero, PG Szilagyi, ), Los Angeles, Calif; UCLA NRSA T32 Primary Care Research Fellowship, University of California, Los Angeles (A Gallegos, PG Szilagyi, PJ Chung), Calif
| | - Bergen B Nelson
- Children's Hospital of Richmond at Virginia Commonwealth University (BB Nelson), Richmond, Va
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Anselem O, Saurel-Cubizolles MJ, Khoshnood B, Blondel B, Sauvegrain P, Bertille N, Azria E. Does women's place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France. BMC Pregnancy Childbirth 2021; 21:590. [PMID: 34461849 PMCID: PMC8406966 DOI: 10.1186/s12884-021-04041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background To examine disparities by maternal place of birth in the opportunity to make an informed choice about Down syndrome screening, in France, where the national guidelines recommend that physicians offer it to all pregnant women. Methods We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator. Results Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and the maternity unit’s level of perinatal care, women born outside France had the opportunity to make an informed choice less often than women born in France. This association remained essentially the same even after excluding women without adequate prenatal care. Conclusions Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.
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Affiliation(s)
- Olivia Anselem
- Maternité Port-Royal, APHP.Centre-Université de Paris, FHU PREMA, 123 boulevard de Port-Royal, 75014, Paris, France.
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Babak Khoshnood
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Université Paris, Paris, France
| | - Nathalie Bertille
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France
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An Examination of History for Promoting Diversity in Neuroscience. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:202-213. [PMID: 34393663 PMCID: PMC8349702 DOI: 10.1007/s40140-021-00464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
Purpose of Review A review of American history is presented to understand how public policy has contributed to a disproportionate burden of disease in members of underrepresented groups. A review of research conducted in the Stroke Belt provides an opportunity to examine more closely traditional and non-traditional risk factors in an effort to consider strategies for change. Recent Findings A diverse physician workforce has been offered as a way of improving care for our increasingly diverse populace. Given the expected increased prevalence of stroke in communities of color and the impact of stress from discrimination on health, proactive strategies to promote inclusion and equity to support diversity in perioperative neuroscience is warranted. Summary Public policy rooted in structural racism has left marginalized groups economically and educationally disadvantaged with less access to health care. Mistrust and fear from ongoing discrimination compels the neuroscience community to broaden their approach for developing a more reassuring and supportive educational environment for patients and trainees.
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Michlig JR, Stelter AJ, Czarnecki ML, Norton A, Korom N, Hainsworth K. Pediatric healthcare professionals' perceptions, knowledge, and use of essential oils. Complement Ther Clin Pract 2021; 45:101474. [PMID: 34388559 DOI: 10.1016/j.ctcp.2021.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Complementary and Integrative Medicines (CIM) are widely used by adults and children. Despite this, studies have shown that Healthcare Professionals' (HCPs) views about CIM vary. Because underlying knowledge, perceptions and biases may influence HCPs' acceptance of a new aromatherapy program, the investigators sought to assess HCPs' views regarding aromatherapy before implementing an aromatherapy program in a pediatric hospital. DESIGNS AND MEASURES A convenience sample of HCPs at an academic pediatric hospital in the United States completed an investigator developed online questionnaire about their perceptions, knowledge, and use of essential oils. RESULTS The sample included 987 respondents, of which: 62.0% were nurses. Overall, 94.2% of HCPs indicated that they "rarely, never, or seldomly" discussed essential oil use with patients. Most indicated a willingness to incorporate essential oils into their patient care with appropriate education. Furthermore, 47.4% of HCPs reported positive views about the use of essential oils, 4.9% reported negative views and opinions, and 45% raised specific concerns about safety, education and/or evidence. CONCLUSION Overall, this study suggests that HCPs have limited knowledge regarding essential oils, are open to learning more about them, and would like more evidence specifically regarding the efficacy and safety of using essential oils in pediatrics. Additionally, most HCPs are not currently discussing essential oils with pediatric patients. However, they are open to incorporating them into their patients' care if they receive proper education, and are open to our organization implementing an aromatherapy program if appropriate education and safety measures are provided.
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Affiliation(s)
- Johanna R Michlig
- Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA; Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA.
| | - Ashley J Stelter
- Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | | | - Anita Norton
- Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Nancy Korom
- Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Keri Hainsworth
- Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA; Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
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141
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Keister LA, Stecher C, Aronson B, McConnell W, Hustedt J, Moody JW. Provider Bias in prescribing opioid analgesics: a study of electronic medical Records at a Hospital Emergency Department. BMC Public Health 2021; 21:1518. [PMID: 34362330 PMCID: PMC8344207 DOI: 10.1186/s12889-021-11551-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes influence doctors’ treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics bias provider prescribing of opioid analgesics. Methods We used electronic medical record data from an emergency department of a large U.S hospital during years 2008–2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis codes and between-patient heterogeneity. Results A total of 180,829 patient visits for 63,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, later times of day, earlier in the week, later years in our sample, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and sex. Conclusions Providers tend to prescribe fewer opioids during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Potential harms resulting from previous treatment decisions may accumulate by informing future treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11551-9.
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Affiliation(s)
- Lisa A Keister
- Department of Sociology, Duke Network Analysis, Sanford School of Public Policy, Duke University, Durham, NC, 27705, USA.
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - Brian Aronson
- The Adecco Group, 10151 Deerwood Park Blvd bldg 200 ste 101, Jacksonville, FL, 32256, USA
| | - William McConnell
- Department of Sociology, Florida Atlantic University, 777 Glades Road
- CU 97 Rm 253, Boca Raton, FL, 33431, USA
| | - Joshua Hustedt
- Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, 85004, USA
| | - James W Moody
- Department of Sociology, Duke Network Analysis, Duke University, Durham, NC, 27705, USA
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142
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Phelan SM, Puhl RM, Burgess DJ, Natt N, Mundi M, Miller NE, Saha S, Fischer K, van Ryn M. The role of weight bias and role-modeling in medical students' patient-centered communication with higher weight standardized patients. PATIENT EDUCATION AND COUNSELING 2021; 104:1962-1969. [PMID: 33487507 DOI: 10.1016/j.pec.2021.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patients with obesity may experience less patient-centered care. We assessed whether medical students' implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity. METHODS Third and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed. RESULTS Student perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=-0.19, p = 0.01), friendliness (b=-0.28, p < 0.001), responsiveness (b=-0.21, p = 0.002), respectfulness (b=-0.17, p = 0.003), interactivity (b=-0.22, p = 0.003), likelihood of being recommended by observers (b=-0.34, p < 0.001), and patient-centeredness index scores (b=-0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=-0.16, p = 0.03), recommendation likelihood (b=-0.22, p = 0.04), and patient-centeredness index score (b=-0.12, p = 0.03). CONCLUSIONS Negative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity. PRACTICE IMPLICATIONS Efforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.
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Affiliation(s)
- Sean M Phelan
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA; Department of Human Development & Family Studies, University of Connecticut, Storrs, CT, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Neena Natt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Manpreet Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Somnath Saha
- VA Portland Health Care System, Portland, OR, USA; Department of Internal Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kristin Fischer
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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143
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Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias. Simul Healthc 2021; 16:275-284. [PMID: 34398114 DOI: 10.1097/sih.0000000000000591] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY STATEMENT Simulation-based education is a particularly germane strategy for addressing the difficult topic of racism and implicit bias due to its immersive nature and the paradigm of structured debriefing. Researchers have proposed actionable frameworks for implicit bias education, particularly outlining the need to shift from recognition to transformation, with the goal of changing discriminatory behaviors and policies. As simulation educators tasked with training health care professionals, we have an opportunity to meet this need for transformation. Simulation can shift behaviors, but missteps in design and implementation when used to address implicit bias can also lead to negative outcomes. The focus of this article is to provide recommendations to consider when designing simulation-based education to specifically address racism and implicit bias.
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Affiliation(s)
- Samreen Vora
- From the Simulation Program (S.V.), Children's Minnesota, Minneapolis, MN; Center for Professional Development and Practice (B.D.), Children's Minnesota, Minneapolis, MN; Department of Pediatrics and Medical Education (M.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York City, NY; Department of Pediatrics (V.F.J.), University of Louisville, Louisville, KY; Division of Education and Training (S.K.), The University of Texas MD Anderson Cancer Center, Houston, TX; and Department of Pediatricsa (A.C.), University of Louisville, Norton Children's Hospital, Louisville, KY
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144
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Nair AA, Farber HJ, Chen H. Utilization of opioid versus non-opioid analgesics in Medicaid and CHIP enrolled children with current asthma. Pharmacoepidemiol Drug Saf 2021; 30:1520-1531. [PMID: 34322934 DOI: 10.1002/pds.5336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Opioid analgesics are frequently dispensed in children despite its known risk in children with a compromised airway function. The objectives of the study were to assess the prevalence of opioid analgesic dispensing in children with current asthma and to identify patient and prescriber factors associated with the dispensing of opioid versus non-opioid analgesics. METHODS Children <18 years of age, having current asthma and receiving an incident analgesic prescription were identified from a large Medicaid Managed Care Plan during years 2013 through 2018. Current asthma was defined as both receiving an asthma diagnosis and filling an anti-asthmatic medication during the 12-month period prior to the analgesic medication initiation. A scoring algorithm was applied to associate analgesic prescription with procedures and diagnoses according to perceived need for analgesia and time proximity. RESULTS Of the 9529 children meeting the inclusion criteria, 2681 (28.1%) received an opioid prescription. Opioid analgesic dispensing was most common among children who had an outpatient surgery/procedure (29.4%), trauma (19.4%) dental procedure (18.4%), and respiratory infection (10.6%). Multivariable analysis indicated that non-Hispanic Black (AOR: 0.39[0.3-0.5]) and Hispanic (AOR: 0.51[0.4-0.6]) children were less likely to receive an opioid analgesic compared to their non-Hispanic White counterparts. Children with prior history of asthma-related emergency department visit (AOR: 1.24[1.0-1.5]) and short acting beta agonist overuse (AOR: 1.33[1.1-1.7]) were more likely to fill an opioid analgesic prescription than those without. CONCLUSION Opioid analgesics are frequently dispensed to children with asthma. A higher dispensing rate was observed among non-Hispanic White children and among those with a history of uncontrolled asthma.
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Affiliation(s)
- Abhishek A Nair
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.,Medical Affairs, Texas Children's Health Plan, Houston, Texas, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
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145
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Afulani PA, Ogolla BA, Oboke EN, Ongeri L, Weiss SJ, Lyndon A, Mendes WB. Understanding disparities in person-centred maternity care: the potential role of provider implicit and explicit bias. Health Policy Plan 2021; 36:298-311. [PMID: 33491086 DOI: 10.1093/heapol/czaa190] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Studies in low-resource settings have highlighted disparities in person-centred maternity care (PCMC)-respectful and responsive care during childbirth-based on women's socioeconomic status (SES) and other characteristics. Yet few studies have explored factors that may underlie these disparities. In this study, we examined implicit and explicit SES bias in providers' perceptions of women's expectations and behaviours, as well as providers' general views regarding factors influencing differential treatment of women. We conducted a convergent mixed-methods study with 101 maternity providers in western Kenya. Implicit SES bias was measured using an adaptation of the Implicit Association Test (IAT) and explicit SES bias assessed using situationally specific vignettes. Qualitative data provided additional details on the factors contributing to disparities. Results provide evidence for the presence of both implicit and explicit bias related to SES that might influence PCMC. Differential treatment was linked to women's appearance, providers' perceptions of women's attitudes, assumptions about who is more likely to understand or be cooperative, women's ability to advocate for themselves or hold providers accountable, ability to pay for services in a timely manner, as well as situational factors related to stress and burnout. These factors interact in complex ways to produce PCMC disparities, and providing better care to certain groups does not necessarily indicate preference for those groups or a desire to provide better care to them. The findings imply the need for multilevel approaches to addressing disparities in maternity care. This should include provider training on PCMC and their biases, advocacy for women of low SES, accountability mechanisms, and structural and policy changes within health care settings.
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Affiliation(s)
- Patience A Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA.,UCSF Institute for Global Health Sciences, San Francisco, CA, USA
| | - Beryl A Ogolla
- Global Programs for Research and Training, Nairobi, Kenya
| | - Edwina N Oboke
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Sandra J Weiss
- UCSF Department of Community Health Systems, San Francisco, CA 94143, USA
| | - Audrey Lyndon
- NYU Rory Meyers College of Nursing, New York, NY, USA
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146
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Boring BL, Walsh KT, Nanavaty N, Ng BW, Mathur VA. How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others' Use of Numerical Pain Scales. Front Psychol 2021; 12:663890. [PMID: 34282355 PMCID: PMC8285731 DOI: 10.3389/fpsyg.2021.663890] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.
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Affiliation(s)
- Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Kaitlyn T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Brandon W Ng
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States.,Texas A&M Institute for Neuroscience, College Station, TX, United States
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147
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Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2118801. [PMID: 34323984 PMCID: PMC8322998 DOI: 10.1001/jamanetworkopen.2021.18801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. OBJECTIVE To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. INTERVENTIONS The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. MAIN OUTCOMES AND MEASURES Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. RESULTS Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients' treatment preferences and risk of opioid misuse. CONCLUSIONS AND RELEVANCE In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03134092.
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Affiliation(s)
- Eden Engel-Rebitzer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Abby R. Dolan
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Frances S. Shofer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Max Jordan Nguemeni Tiako
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Yale School of Medicine, New Haven, Connecticut
| | - Marilyn M. Schapira
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of General and Internal Medicine, University of Pennsylvania, Philadelphia
| | - Jeanmarie Perrone
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Penn Center for Addiction Medicine and Policy, Philadelphia, Pennsylvania
| | - Erik P. Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karin V. Rhodes
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Venkatesh R. Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Carolyn C. Cannuscio
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Erica Goldberg
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Jeffrey Bell
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Melissa A. Rodgers
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- College of Education, University of Texas at Austin, Austin
| | - Michael Zyla
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Lance B. Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
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Gonzalez CM, Nava S, List J, Liguori A, Marantz PR. How Assumptions and Preferences Can Affect Patient Care: An Introduction to Implicit Bias for First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11162. [PMID: 34263027 PMCID: PMC8236500 DOI: 10.15766/mep_2374-8265.11162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/04/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Instruction in implicit bias is becoming prevalent across the spectrum of medical training. Little education exists for preclinical students, and guidance for faculty to facilitate such education is minimal. To address these gaps, we designed and delivered a single session for incoming first-year medical students and developed a facilitator training program. METHODS One faculty member delivered a 1-hour, multimedia, interactive lecture to all first-year medical students. Students subsequently met in small groups with trained facilitators. Activities included reflection, guided debriefing, and strategy identification to become aware of when they might be making an assumption causing them to jump to a conclusion about someone. The program evaluation consisted of aggregated student strategies and facilitator feedback during postsession debriefs, both analyzed through thematic analysis. RESULTS We delivered instruction to 1,098 students. Student strategies resulted in three themes: (1) humility, (2) reflection, and (3) partnering. The postsession debriefs uncovered opportunities to enhance the session. Lessons learned included presenting material to an entire class at once, allowing students to engage in dynamic discussion in the small groups, eliminating anonymous polling in the small groups, and highlighting management of implicit bias as essential to professional development. DISCUSSION Our instructional design enabled first-year medical students to identify at least one strategy to use when implicit biases are activated. The large-group session was deliverable by one faculty member, and volunteers successfully facilitated small-group sessions after only one training session, making this model a feasible innovation to reach an entire medical school class at the same time.
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Affiliation(s)
- Cristina M. Gonzalez
- Professor, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Stephanie Nava
- Research Assistant, Department of Medicine, Albert Einstein College of Medicine
| | - Julie List
- Principal Associate, Department of Family and Social Medicine, Albert Einstein College of Medicine
| | - Alyssa Liguori
- Research Assistant, Department of Medicine, Albert Einstein College of Medicine
| | - Paul R. Marantz
- Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine; Professor, Department of Medicine, Albert Einstein College of Medicine; Associate Dean for Clinical Research Education, Albert Einstein College of Medicine
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149
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Groves PS, Bunch JL, Sabin JA. Nurse bias and nursing care disparities related to patient characteristics: A scoping review of the quantitative and qualitative evidence. J Clin Nurs 2021; 30:3385-3397. [PMID: 34021653 DOI: 10.1111/jocn.15861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Investigations of healthcare workers' implicit attitudes about patient characteristics and differences in delivery of healthcare due to bias are increasingly common. However, there is a gap in our understanding of nurse-specific bias and care disparities. AIMS To identify (a) the types of available evidence, (b) key factors and relationships identified in the evidence and (c) knowledge gaps related to nurse bias (nurse attitudes or beliefs towards a patient characteristic) and nursing care disparities (healthcare disparities related specifically to nursing care). METHODS Authors completed a scoping review using the Joanne Briggs Institute method and PRISMA-SCR checklist. Five databases were searched. After screening, 215 research reports were included and examined. Data were extracted from research reports and assessed for thematic patterns and trends across multiple characteristics. RESULTS Nurse bias and/or care disparity investigations have become increasingly common over the 38-year span of included reports. Multiple patient characteristics have been investigated, with the most common being race and/or ethnicity, gender and age. Twenty-nine of 215 studies identified a potential relationship between nurse bias regarding a characteristic and nursing care of individuals with that characteristic. Of these studies, 27 suggested the bias was associated with a negative disparate impact on nursing care. Only 12 reports included evaluating an intervention designed to reduce nurse bias or nursing care-related healthcare disparities. CONCLUSIONS Despite increasing research focus on individual bias and disparities in healthcare, the accumulated knowledge regarding nurses has not significantly advanced past a descriptive, exploratory level. Nor has there been a consistent focus on the role of nurses, who represent the largest component of the professional healthcare workforce. RELEVANCE TO CLINICAL PRACTICE National and international codes of ethics for nurses require provision of care according to individual, unique patient need, disregarding bias and incorporating patient characteristics into their plan of care.
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Affiliation(s)
| | | | - Janice A Sabin
- School of Medicine, University of Washington, Seattle, WA, USA
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150
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Lincoln KD, Chow T, Gaines BF, Fitzgerald T. Fundamental causes of barriers to participation in Alzheimer's clinical research among African Americans. ETHNICITY & HEALTH 2021; 26:585-599. [PMID: 30375237 DOI: 10.1080/13557858.2018.1539222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Objectives: African Americans have a significantly higher risk than Whites for developing Alzheimer's disease (AD), but show lower participation in AD clinical trials. Studies of African Americans' involvement in clinical research have identified fear and mistrust of research as barriers to participation. Historical occurrences of unethical research practices are often cited as the source of these attitudes, but underlying factors such as African Americans' experiences of racism and discrimination remain unexplored. The goal of this study was to examine the roles of race and culture in the attitudes and beliefs of African Americans about participating in clinical research.Design: Five focus groups were conducted with 44 African American men and women (aged 50 and over) in a western U.S. state. Participants were asked scripted questions regarding their knowledge and beliefs about AD and their feelings about participating in clinical research. A taxonomy was created to organize results based on participant responses.Results: Four major thematic clusters emerged that influence African Americans beliefs about and participation in clinical research: (a) experiences of unequal treatment and racism, (b) cultural trauma due to historical events and contemporary experiences, (c) racial identity and cultural norms, and (d) the importance of cultural competency and racial congruence in recruitment and research studies.Conclusions: Understanding, acknowledging, and addressing the factors that underlie mistrust and fear of research is important to build trust and to develop culturally appropriate outreach, education, and recruitment strategies that will increase African Americans' participation in clinical research.
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Affiliation(s)
- Karen D Lincoln
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Tiffany Chow
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Bryan F Gaines
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Terence Fitzgerald
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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