Racial disparities in provider-patient communication of incidental medical findings

Understanding Implicit Bias and Its Impact in Veterinary Medicine

Implicit biases are those we are unwilling to admit, yet they influence our behavior in ways that impact our experience in the workplace. Literature demonstrates that implicit bias influences career choice and limits success within a chosen career. Discrimination in the veterinary workplace is pervasive and has a negative impact that is responsible for financial loss. It can also influence client communication, patient-care, and be inadvertently perpetuated by well-meaning community clinics. Strategies can be employed to acknowledge implicit bias and to foster behavioral change, which results in a healthier workplace and improved client and patient-care.

Compassionate Curiosity: Mitigating the Effects of Bias Through Motivational Interviewing

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient's point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

Exploring health advice by dental professionals in USA: A secondary data analysis of NHANES (2015-2018)

OBJECTIVES

To examine socioeconomic and ethnic variations in the provision of health advice by dental professionals.

METHODS

Data were from the National Health and Examination Survey (NHANES) (2015-2018). Socioeconomic position (Poverty-income ratio and education) and ethnicity were the main exposures. The outcome variable of interest was whether participants received health advice regarding the "benefits of quitting cigarettes," "benefits of monitoring blood sugar levels," and "importance of oral cancer screening". Logistic regression analysis was used to examine the relationship between socioeconomic factors/ethnicity, and health advice after adjusting for covariates.

RESULTS

The analysis included a total of 5524 people aged eighteen and above who had complete data. Black and Hispanic individuals had higher odds of receiving advice on smoking (OR = 1.49, 95% CI: 1.04-2.12 and OR = 1.48, 95% CI: 1.05-2.07, respectively) and glucose monitoring (OR = 3.00, 95% CI: 2.03-4.43 and OR = 3.14, 95% CI: 2.04-4.82, respectively), but no significant difference for cancer screening advice.Higher poverty-income ratios (PIR) were associated with lower odds of receiving smoking advice (OR = 0.91, 95% CI: 0.84-0.98), but no significant associations were observed for glucose monitoring or cancer screening advice. The study's findings reveal a social gradient in the provision of cancer advice, with individuals having higher education levels, particularly university education (OR = 1.69, 95% CI: 1.24-2.31), showing significantly higher odds of receiving cancer screening advice CONCLUSION: The study highlights significant variations in health advice provision in dental settings, with education level, ethnicity, and smoking status playing prominent roles, emphasizing the need for targeted interventions to promote equity and cultural competence in delivering health advice in dental settings.

PRACTICE IMPLICATION

The results emphasize the importance of strong policies and ongoing education for dental professionals to ensure optimal treatment and prevention.

Identifying facilitators and barriers to culturally responsive communication for racial, ethnic, sexual, and gender minoritized patients when screened for COVID-19 vaccinations: A scoping review protocol

INTRODUCTION

Racial, ethnic, sexual, and gender minoritized groups are considered historically excluded groups and have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. The influence of social determinants of health (SDOH), including access to screening and treatment, and other systemic and structural factors are largely responsible for these disparities. Primary care practitioner (PCP) competence in culturally responsive screening practices will be critical to reducing the impact of systemic and structural factors serving as barriers to screening and treatment. Correspondingly, improving the capacity of PCPs to communicate with patients in a culturally responsive manner may influence improved screening and treatment outcomes for minoritized groups related to COVID-19. This scoping literature review aims to determine the current breadth of literature on culturally responsive communication (CRC) in regard to COVID-19 vaccination screening for historically excluded, or minoritized groups. Results from this review will inform the development of a training series and social marketing campaign to improve PCPs capacity in CRC. This manuscript provides details on our study protocol.

OBJECTIVES

This scoping literature review aims to analyze existing literature on culturally responsive COVID-19 vaccinations between PCPs and patients in the U.S., specifically for racial, ethnic, sexual, and gender minoritized groups. Results of this scoping review will inform the development of a training series and social marketing campaign to improve capacity of PCPs in this area. Additionally, the review will inform recommendations for future research.

MATERIALS AND METHODS

This scoping review will be performed following the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Relevant studies between the years 2019-2022 were identified using a rigorous search strategy across four databases: MEDLINE (via PubMed), Scopus, Cochrane (CENTRAL; via Wiley), and CINAHL (via EBSCO), using Boolean and Medical Subject Headings (MeSH) search terms. Studies will be uploaded to the data extraction tool, Covidence, to remove duplicates and perform a title/abstract screening, followed by a full-text screening.

RESULTS

The data extraction and analysis phases of the scoping review are in progress. Data will be analyzed for themes related to culturally responsive COVID-19 screening practices in clinical encounters with the identified study populations. Results will be reported by theme and align to PRISMA-ScR guidelines.

DISCUSSION

To our knowledge, this is the first study to use scoping methods to investigate the barriers and facilitators to CRC of COVID-19 vaccine screening for historically excluded communities in the U.S. The work and results from this research will be directly utilized for the development of nationally-accessible, continuing medical education materials to teach PCPs about CRC, as well as other materials to influence relevant policy changes within the healthcare landscape.

US Older Adults with Multiple Chronic Conditions Perceptions of Provider-Patient Communication: Trends and Racial Disparities from MEPS 2013-2019

BACKGROUND

Multiple chronic conditions (MCC) require complex patient-centered approaches with effective provider-patient communication.

OBJECTIVE

To describe trends in patient perceptions of provider-patient communication during non-emergency care and identify associated racial disparities in US older adults with MCC.

DESIGN, SETTING, PARTICIPANTS

Observational study using pooled US Medical Expenditure Panel Survey (2013-2019) data included adults > 65 with two or more chronic conditions.

MAIN MEASURES

Provider-patient communication was measured by four indicators (how often their doctor explained things clearly, listened carefully, showed respect, and spent enough time with them). The primary outcomes were the annual rates of reporting "always" for the communication indicators. Cochran-Armitage trend tests examined the trends of reporting "always" and associated racial disparities. Multivariable logistic regression identified racial and other factors associated with respondents choosing "always" for one or more categories for provider-patient communication, defined as positive communication.

RESULTS

Among 9758 older adults with MCC, declining trends for positive communication were shown across all provider-patient communication categories during 2013 to 2019 (p<0.001). The greatest decrease occurred in "always listening carefully", from 68.6% in 2013 to 59.1% in 2019 (p<0.001). The declining trends of four communication measures in non-Hispanic Whites with MCC were significant (p<0.001). Older adults from Hispanic or Non-Hispanic Black racial backgrounds were 28 to 51% more likely to report "always" for the four indicators of provider-patient communication than non-Hispanic Whites after adjusting for respondents' characteristics.

CONCLUSION

The rates of "always" reporting positive communication with providers significantly declined from 2013 to 2019 in older adults with MCC, particularly in non-Hispanic Whites. Hispanics and non-Hispanic Blacks were more likely to report positive communication with providers than other races.

White Paper: Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging

PURPOSE

Actionable incidental findings (AIFs) are common in radiologic imaging. Imaging is commonly performed in emergency department (ED) visits, and AIFs are frequently encountered, but the ED presents unique challenges for communication and follow-up of these findings. The authors formed a multidisciplinary panel to seek consensus regarding best practices in the reporting, communication, and follow-up of AIFs on ED imaging tests.

METHODS

A 15-member panel was formed, nominated by the ACR and American College of Emergency Physicians, to represent radiologists, emergency physicians, patients, and those involved in health care systems and quality. A modified Delphi process was used to identify areas of best practice and seek consensus. The panel identified four areas: (1) report elements and structure, (2) communication of findings with patients, (3) communication of findings with clinicians, and (4) follow-up and tracking systems. A survey was constructed to seek consensus and was anonymously administered in two rounds, with a priori agreement requiring at least 80% consensus. Discussion occurred after the first round, with readministration of questions where consensus was not initially achieved.

RESULTS

Consensus was reached in the four areas identified. There was particularly strong consensus that AIFs represent a system-level issue, with need for approaches that do not depend on individual clinicians or patients to ensure communication and completion of recommended follow-up.

CONCLUSIONS

This multidisciplinary collaboration represents consensus results on best practices regarding the reporting and communication of AIFs in the ED setting.

Systematic review: sleep health in the US Latinx population

Sleep disturbances are a common and unmet health problem in Latinx. While Latinx report similar sleep disturbances as non-Hispanic Whites [NHW], Latinx suffer from these disturbances to a greater degree than their NHW counterparts. Sleep disturbances are associated with increased risk of chronic health conditions, which Latinx experience at high rates. Research also points to significant sleep differences within Latinx. Given that Latinx are a rapidly growing population in the United States, sleep disparities between Latinx and NHWs and sleep differences within Latinx warrant further investigation. While research on Latinx sleep is growing, the last narrative review on US Latinx sleep health was published by Loredo and colleagues in 2010. Our narrative review expands on Loredo et al.'s work, adding the literature on Latinx sleep published since 2010 (N = 70). A total of 78 peer-reviewed articles related to young to middle-aged (i.e., 18-65 years) healthy Latinx adult sleep were identified in three databases-PsycInfo, PubMed/Medline, and Web of Science. With the socioecological model as framework, this review (1) summarizes current evidence pertaining to sleep health in healthy, community dwelling, urban Latinx adults; (2) discusses measurement challenges related to investigating Latinx sleep disparities and differences; and (3) discusses potential contributors to Latinx sleep. The prevalence of short sleep duration, long sleep duration, and poor sleep quality is high among Latinx; there are differences by Latinx subgroup. Our review identifies several multi-level influences associated with poor sleep: SES, sexual minority status, racial discrimination, access to care, neighborhood environment, and shift work. N = 250/250.

Motives for and Barriers to Research Participation Among Racially and Ethnically Diverse Veterans

INTRODUCTION

Veterans in general-and especially those who identify as Veterans of color-are underrepresented in health-related treatment research. This contributes to health inequity by hindering the development of evidence-based treatment recommendations for people of color. This project utilized culturally centered research procedures to identify health-related research priorities and examine motives for and barriers to research participation in a diverse sample of Veterans.

MATERIALS AND METHODS

Veterans (N = 330, 32% female; 36% Black, 28% White, 15% Latinx, 12% Asian, 4% Multiracial) reported their experiences with and perspectives on health-related research online from remote locations. Linear regression was used to test associations between discrimination and motives/barriers for research. All procedures were approved by the Institutional Review Board (#2033562).

RESULTS

Participants identified psychological concerns, particularly PTSD, as research priorities for Veterans in their communities, but also prioritized physical problems (e.g., brain injury) and social concerns (e.g., homelessness, access to care). Perceptions of, motives for, and barriers to research were similar across racial/ethnic groups. The most common motive was contributing to research that seems important, and the most common barrier was not knowing about research opportunities. Every-day experiences with discrimination (e.g., people acting as if they are afraid of you because of your race/ethnicity) were associated with more barriers to research among Black participants.

CONCLUSIONS

Experiences of racial/ethnic discrimination are associated with different research-related outcomes across racial/ethnic groups. Efforts to engage diverse populations should prioritize access to (not willingness to participate in) health-related research.

Detecting Racial/Ethnic Health Disparities Using Deep Learning From Frontal Chest Radiography

PURPOSE

The aim of this study was to assess racial/ethnic and socioeconomic disparities in the difference between atherosclerotic vascular disease prevalence measured by a multitask convolutional neural network (CNN) deep learning model using frontal chest radiographs (CXRs) and the prevalence reflected by administrative hierarchical condition category codes in two cohorts of patients with coronavirus disease 2019 (COVID-19).

METHODS

A CNN model, previously published, was trained to predict atherosclerotic disease from ambulatory frontal CXRs. The model was then validated on two cohorts of patients with COVID-19: 814 ambulatory patients from a suburban location (presenting from March 14, 2020, to October 24, 2020, the internal ambulatory cohort) and 485 hospitalized patients from an inner-city location (hospitalized from March 14, 2020, to August 12, 2020, the external hospitalized cohort). The CNN model predictions were validated against electronic health record administrative codes in both cohorts and assessed using the area under the receiver operating characteristic curve (AUC). The CXRs from the ambulatory cohort were also reviewed by two board-certified radiologists and compared with the CNN-predicted values for the same cohort to produce a receiver operating characteristic curve and the AUC. The atherosclerosis diagnosis discrepancy, Δ_vasc, referring to the difference between the predicted value and presence or absence of the vascular disease HCC categorical code, was calculated. Linear regression was performed to determine the association of Δ_vasc with the covariates of age, sex, race/ethnicity, language preference, and social deprivation index. Logistic regression was used to look for an association between the presence of any hierarchical condition category codes with Δ_vasc and other covariates.

RESULTS

The CNN prediction for vascular disease from frontal CXRs in the ambulatory cohort had an AUC of 0.85 (95% confidence interval, 0.82-0.89) and in the hospitalized cohort had an AUC of 0.69 (95% confidence interval, 0.64-0.75) against the electronic health record data. In the ambulatory cohort, the consensus radiologists' reading had an AUC of 0.89 (95% confidence interval, 0.86-0.92) relative to the CNN. Multivariate linear regression of Δ_vasc in the ambulatory cohort demonstrated significant negative associations with non-English-language preference (β = -0.083, P < .05) and Black or Hispanic race/ethnicity (β = -0.048, P < .05) and positive associations with age (β = 0.005, P < .001) and sex (β = 0.044, P < .05). For the hospitalized cohort, age was also significant (β = 0.003, P < .01), as was social deprivation index (β = 0.002, P < .05). The Δ_vasc variable (odds ratio [OR], 0.34), Black or Hispanic race/ethnicity (OR, 1.58), non-English-language preference (OR, 1.74), and site (OR, 0.22) were independent predictors of having one or more hierarchical condition category codes (P < .01 for all) in the combined patient cohort.

CONCLUSIONS

A CNN model was predictive of aortic atherosclerosis in two cohorts (one ambulatory and one hospitalized) with COVID-19. The discrepancy between the CNN model and the administrative code, Δ_vasc, was associated with language preference in the ambulatory cohort; in the hospitalized cohort, this discrepancy was associated with social deprivation index. The absence of administrative code(s) was associated with Δ_vasc in the combined cohorts, suggesting that Δ_vasc is an independent predictor of health disparities. This may suggest that biomarkers extracted from routine imaging studies and compared with electronic health record data could play a role in enhancing value-based health care for traditionally underserved or disadvantaged patients for whom barriers to care exist.