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Marsh JK, Asan O, Kleinberg S. Perceived Penalties for Sharing Patient Beliefs with Health Care Providers. Med Decis Making 2024:272989X241262241. [PMID: 39092564 DOI: 10.1177/0272989x241262241] [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: 08/04/2024]
Abstract
BACKGROUND Health care interactions may require patients to share with a physician information they believe but is incorrect. While a key piece of physicians' work is educating their patients, people's concerns of being seen as uninformed or incompetent by physicians may lead them to think that sharing incorrect health beliefs comes with a penalty. We tested people's perceptions of patients who share incorrect information and how these perceptions vary by the reasonableness of the belief and its centrality to the patient's disease. DESIGN We recruited 399 United States Prolific.co workers (357 retained after exclusions), 200 Prolific.co workers who reported having diabetes (139 after exclusions), and 244 primary care physicians (207 after exclusions). Participants read vignettes describing patients with type 2 diabetes sharing health beliefs that were central or peripheral to the management of diabetes. Beliefs included true and incorrect statements that were reasonable or unreasonable to believe. Participants rated how a doctor would perceive the patient, the patient's ability to manage their disease, and the patient's trust in doctors. RESULTS Participants rated patients who shared more unreasonable beliefs more negatively. There was an extra penalty for incorrect statements central to the patient's diabetes management (sample 1). These results replicated for participants with type 2 diabetes (sample 2) and physician participants (sample 3). CONCLUSIONS Participants believed that patients who share incorrect information with their physicians will be penalized for their honesty. Physicians need to be educated on patients' concerns so they can help patients disclose what may be most important for education. HIGHLIGHTS Understanding how people think they will be perceived in a health care setting can help us understand what they may be wary to share with their physicians.People think that patients who share incorrect beliefs will be viewed negatively.Helping patients share incorrect beliefs can improve care.
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Affiliation(s)
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Samantha Kleinberg
- Department of Computer Science, Stevens Institute of Technology, Hoboken, NJ, USA
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Shi Y, Heien HC, Orvidas LJ, Sangaralingham LR, Halbauer M, Warner DO, Phelan S. Racial and Ethnic Disparities in Otolaryngology Office Visit and Tympanostomy Tube Placement in Children with Otitis Media. Laryngoscope 2024; 134:3846-3852. [PMID: 38450789 DOI: 10.1002/lary.31380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Racial disparities are pervasive in access to pediatric surgery. The goal of this study was to test the hypotheses that, compared with White children, non-White and Hispanic children: (1) were less likely to attend evaluations by otolaryngologists after a diagnosis of otitis media (OM) eligible for surgical referral, and (2) these children were less likely to receive tympanostomy tube (TT) after surgical consultation. METHODS The OptumLabs Data Warehouse is a de-identified claims database of privately insured enrollees. Guidelines on the management of OMs suggest that children should be evaluated for surgery if they have recurrent acute OM or chronic OM with effusion. A cohort of children who were diagnosed with OM were constructed. For Hypothesis 1, the primary outcome was otolaryngology office visit within 6 months of a diagnosis of recurrent or chronic OM. For Hypothesis 2, the outcome was TT placement within 6 months following the otolaryngology office visit. Cox regression models were used to determine the relationship between race/ethnicity and the primary outcomes. RESULTS Among 187,776 children with OMs, 72,774 (38.8%) had otolaryngology visits. In a multivariate Cox model, the hazard ratios of attending otolaryngology visit for Black, Hispanic, and Asian children were 0.93 (95% CI,0.90, 0.96), 0.86 (0.83, 0.88), and 0.74 (0.71, 0.77), compared with White children. Among the children evaluated by otolaryngologists, 46,554 (63.97%) received TT. Black, Hispanic, and Asian children with recurrent acute OM had lower likelihood of receiving TT. CONCLUSIONS Racial disparities in attending otolaryngology office visit contributed to the disparities in receiving TT. QUALITY OF EVIDENCE Level 3 Laryngoscope, 134:3846-3852, 2024.
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Affiliation(s)
- Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Herbert C Heien
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Laura J Orvidas
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Lindsey R Sangaralingham
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
- OptumLabs, Cambridge, Massachusetts, U.S.A
| | - Moira Halbauer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sean Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
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Sanders AA, Roberts JD, McDowell MC, Muller A. The Consequences of Misdiagnosing Race-Based Trauma Response in Black Men: A Critical Examination. SOCIAL WORK IN PUBLIC HEALTH 2024:1-13. [PMID: 39033343 DOI: 10.1080/19371918.2024.2380821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Mental illness is a significant public health concern prevalent in America. Over one in five U.S. adults are affected, yet less than half receive treatment. Among African Americans, only one in three seek treatment with statically lower rates among Black males. Therefore, an accurate diagnosis is crucial for appropriate treatment, while misdiagnosis leads to stigma, discrimination, and untreated illness. This paper examines the implications of misdiagnosing trauma responses in Black men, highlighting systemic biases that impede suitable care and perpetuate negative narratives. The authors propose a conceptual framework incorporating historical trauma, discrimination, and traumatic stress reactions, emphasizing the need for cultural competence and humility. This framework involves public narratives that influence perceptions and judgments, reviewing research evidence, advocating for competent trauma assessments, community empowerment, and future research directions. This paper underscores the importance of understanding and addressing the unique challenges Black men face in mental health diagnosis and treatment.
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Affiliation(s)
- Ashley A Sanders
- College of Health and Human Services, Saginaw Valley State University, University Center, Michigan, USA
| | - J Dontaè Roberts
- School of Health Sciences, Winston Salem State University, Winston-Salem, North Carolina, USA
| | - Melvin C McDowell
- College of Health and Human Services, Saginaw Valley State University, University Center, Michigan, USA
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Job C, Adenipekun B, Cleves A, Gill P, Samuriwo R. Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review. BMJ Open 2024; 14:e081723. [PMID: 38960454 PMCID: PMC11227794 DOI: 10.1136/bmjopen-2023-081723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES. DESIGN JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open. DATA SOURCES Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers. ELIGIBILITY CRITERIA Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES. DATA EXTRACTION AND SYNTHESIS Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews. RESULTS Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES. CONCLUSION HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.
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Affiliation(s)
- Claire Job
- Cardiff University, Cardiff, UK
- Cardiff University, Cardiff, UK
| | | | | | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Ray Samuriwo
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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MacPherson N, Ta B, Ball L, Gunatillaka N, Sturgiss EA. What makes a good general practice consultation? An exploratory pilot study with people from a low socioeconomic background. BJGP Open 2024; 8:BJGPO.2023.0160. [PMID: 38331468 PMCID: PMC11300992 DOI: 10.3399/bjgpo.2023.0160] [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: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND While patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report fewer positive consultation experiences with GPs than patients from higher SES groups. To our knowledge, existing research does not provide an in-depth understanding of the GP conducts that contribute to positive consultations. AIM To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences. DESIGN & SETTING This exploratory pilot study was performed in GP clinics in Melbourne, Australia. METHOD We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients from low SES backgrounds, who reported positive consultation experiences, undertook a semi-structured qualitative interview while watching the video recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers. RESULTS The following four categories were developed: 1) the doctor's demeanour and how the patient was made to feel during the consultation drove their engagement; 2) an established and collaborative therapeutic relationship was of high importance to patients; 3) a doctor's therapeutic skillset was integral to patient confidence and comfort; and 4) patients appreciated verbal and non-verbal communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP. CONCLUSION For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals from low SES backgrounds in primary care and the existing health inequities within this area.
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Affiliation(s)
- Naomi MacPherson
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Binh Ta
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, School of Public Health and School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Anastas T, Wu W, Burgess DJ, Stewart JC, Salyers MP, Kroenke K, Hirsh AT. The Impact of Patient Race, Patient Socioeconomic Status, and Cognitive Load of Physician Residents and Fellows on Chronic Pain Care Decisions. THE JOURNAL OF PAIN 2024; 25:104480. [PMID: 38246252 PMCID: PMC11180591 DOI: 10.1016/j.jpain.2024.01.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Social stereotypes are more likely to influence decision-making under conditions of high cognitive load (ie, mental workload), such as in medical settings. We examined how patient race, patient socioeconomic status (SES), physician cognitive load, and physician implicit beliefs about race and SES differences in pain tolerance impacted physicians' pain treatment decisions. Physician residents and fellows (N = 120) made treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the physicians were randomized to be interrupted during the decision task to make hypertension medication conversion calculations (high cognitive load group), while the other half completed the task without interruptions (low cognitive load group). Both groups were given equal time to make pain care decisions (2.5 minutes/patient). Results of multilevel ordinal logistic regression analyses indicated that physicians prescribed weaker analgesics to patients with high vs. low SES (odds ratio = .68, 95% confidence interval [.48, .97], P = .03). There was also a patient SES-by-cognitive load interaction (odds ratio = .56, 95% confidence interval [.31, 1.01], P = .05) that is theoretically and potentially practically meaningful but was not statistically significant at P < .05. These findings shed light on physician cognitive load as a clinically-relevant factor in the context of pain care quality and equity. PERSPECTIVE: These findings highlight the clinical relevance of physician cognitive load (eg, mental workload) when providing pain care for diverse patients. This line of work can support the development of interventions to manage physician cognitive load and its impact on pain care, which may ultimately help reduce pain disparities.
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Affiliation(s)
- Tracy Anastas
- Department of Psychology, Indiana University Indianapolis
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Family Medicine, University of Washington
| | - Wei Wu
- Department of Psychology, Indiana University Indianapolis
| | - Diana J. Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center
- University of Minnesota Medical School
| | | | | | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine
- Regenstrief Institute, Inc
| | - Adam T. Hirsh
- Department of Psychology, Indiana University Indianapolis
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Zhang L, Richter LR, Wang Y, Ostropolets A, Elhadad N, Blei DM, Hripcsak G. Causal fairness assessment of treatment allocation with electronic health records. J Biomed Inform 2024; 155:104656. [PMID: 38782170 PMCID: PMC11180553 DOI: 10.1016/j.jbi.2024.104656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/31/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Healthcare continues to grapple with the persistent issue of treatment disparities, sparking concerns regarding the equitable allocation of treatments in clinical practice. While various fairness metrics have emerged to assess fairness in decision-making processes, a growing focus has been on causality-based fairness concepts due to their capacity to mitigate confounding effects and reason about bias. However, the application of causal fairness notions in evaluating the fairness of clinical decision-making with electronic health record (EHR) data remains an understudied domain. This study aims to address the methodological gap in assessing causal fairness of treatment allocation with electronic health records data. In addition, we investigate the impact of social determinants of health on the assessment of causal fairness of treatment allocation. METHODS We propose a causal fairness algorithm to assess fairness in clinical decision-making. Our algorithm accounts for the heterogeneity of patient populations and identifies potential unfairness in treatment allocation by conditioning on patients who have the same likelihood to benefit from the treatment. We apply this framework to a patient cohort with coronary artery disease derived from an EHR database to evaluate the fairness of treatment decisions. RESULTS Our analysis reveals notable disparities in coronary artery bypass grafting (CABG) allocation among different patient groups. Women were found to be 4.4%-7.7% less likely to receive CABG than men in two out of four treatment response strata. Similarly, Black or African American patients were 5.4%-8.7% less likely to receive CABG than others in three out of four response strata. These results were similar when social determinants of health (insurance and area deprivation index) were dropped from the algorithm. These findings highlight the presence of disparities in treatment allocation among similar patients, suggesting potential unfairness in the clinical decision-making process. CONCLUSION This study introduces a novel approach for assessing the fairness of treatment allocation in healthcare. By incorporating responses to treatment into fairness framework, our method explores the potential of quantifying fairness from a causal perspective using EHR data. Our research advances the methodological development of fairness assessment in healthcare and highlight the importance of causality in determining treatment fairness.
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Affiliation(s)
- Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren R Richter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Yixin Wang
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; Department of Computer Science, Columbia University, New York, NY, USA
| | - David M Blei
- Department of Statistics, Columbia University, New York, NY, USA; Department of Computer Science, Columbia University, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.
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Lin C, Tu P, Parker T, Mella-Velazquez A, Bier B, Braund WE. The Influences of SES on Patient Choice of Doctor: A Systematic Review. Am J Prev Med 2024:S0749-3797(24)00210-1. [PMID: 38906427 DOI: 10.1016/j.amepre.2024.06.012] [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] [Received: 02/22/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION As patients become increasingly involved in healthcare decision-making, it is important to examine the drivers behind patient choice of doctor (PCOD); the initial decision can have lasting impacts on patients' trust in providers and health outcomes. However, limited studies have explored PCOD relative to socioeconomic status (SES) or health disparity. This review identified similar preferences and varied decision criteria in PCOD across SES groups. METHODS PubMed, PsycINFO, Web of Science, and relevant cross-references were searched for articles published between January 2007-September 2022. Papers were screened using Covidence. Included studies examined PCOD by income and/or educational levels. Analysis was performed in 2022-2023. RESULTS From 4,449 search results, 29 articles were selected (16 countries, 14 medical specialties, total of 32,651 participants). Individuals of higher SES ranked physician characteristics (e.g., qualifications, empathy) or performance more important than cost or convenience. Individuals of lower SES often had to prioritize logistical factors (e.g., insurance coverage, distance) due to resource constraints and gaps in knowledge or awareness about options. Despite differing healthcare systems, such divergence in PCOD were relatively consistent across countries. Some patients, especially females and disadvantaged groups, favored gender-concordant physicians for intimate medical matters (e.g., gynecologist); this partiality was not limited to conservative cultures. Few researchers investigated the outcomes of PCOD and indicated that lower-SES populations inadvertently chose, experienced, or perceived lower quality of care. DISCUSSION Patients' decision criteria varied by SES, even under national systems intended for universal access, indicating the impacts of social determinants and structural inequities. Health education supporting patient decision-making and research on how SES affects PCOD and outcomes could help reduce health disparity.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, North Carolina.
| | - Taylor Parker
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | | | - Brooke Bier
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | - Wendy E Braund
- Pennsylvania Department of Health, Harrisburg, Pennsylvania
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Mora R, Maze M. The role of cultural competency training to address health disparities in surgical settings. Br Med Bull 2024; 150:42-59. [PMID: 38465857 DOI: 10.1093/bmb/ldae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Disparities in health care delivered to marginalized groups are unjust and result in poor health outcomes that increase the cost of care for everyone. These disparities are largely avoidable and health care providers, have been targeted with education and specialised training to address these disparities. SOURCES OF DATA In this manuscript we have sought out both peer-reviewed material on Pubmed, as well as policy statements on the potential role of cultural competency training (CCT) for providers in the surgical care setting. The goal of undertaking this work was to determine whether there is evidence that these endeavours are effective at reducing disparities. AREAS OF AGREEMENT The unjustness of health care disparities is universally accepted. AREAS OF CONTROVERSY Whether the outcome of CCT justifies the cost has not been effectively answered. GROWING POINTS These include the structure/content of the CCT and whether the training should be delivered to teams in the surgical setting. AREAS TIMELY FOR DEVELOPING RESEARCH Because health outcomes are affected by many different inputs, should the effectiveness of CCT be improvement in health outcomes or should we use a proxy or a surrogate of health outcomes.
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Affiliation(s)
- Roberto Mora
- Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Mervyn Maze
- Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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Vandecasteele R, Robijn L, Stevens PAJ, Willems S, De Maesschalck S. "Trying to write a story together": general practitioners' perspectives on culturally sensitive care. Int J Equity Health 2024; 23:118. [PMID: 38844971 PMCID: PMC11154983 DOI: 10.1186/s12939-024-02200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.
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Affiliation(s)
- Robin Vandecasteele
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium.
| | - Lenzo Robijn
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Peter A J Stevens
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, Ghent, 9000, Belgium
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
| | - Stéphanie De Maesschalck
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
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Howard KA, Witrick B, Clark A, Morse A, Atkinson K, Kapoor P, McGinigle KL, Minc S, Alabi O, Hicks CW, Gonzalez A, Cené CW, Cykert S, Kalbaugh CA. Investigating Unconscious Race Bias and Bias Awareness Among Vascular Surgeons. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.04.24308457. [PMID: 38883745 PMCID: PMC11177910 DOI: 10.1101/2024.06.04.24308457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Implicit bias can influence behavior and decision-making. In clinical settings, implicit bias may influence treatment decisions and contribute to health disparities. Given documented Black-White disparities in vascular care, the purpose of this study was to examine the prevalence and degree of unconscious bias and awareness of bias among vascular surgeons treating peripheral artery disease (PAD). Methods The sampling frame included all vascular surgeons who participate in the Vascular Quality Initiative (VQI). Participants completed a survey which included demographic questions, the race implicit association test (IAT) to measure magnitude of unconscious bias, and six bias awareness questions to measure conscious bias. The magnitude of unconscious bias was no preference; or slight, moderate, or strong in the direction of pro-White or pro-Black. Data from participants were weighted to account for nonresponse bias and known differences in the characteristics of surgeons who chose to participate compared to the full registry. We stratified unconscious and conscious findings by physician race/ethnicity, physician sex, and years of experience. Finally, we examined the relationship between unconscious and conscious bias. Results There were 2,512 surgeons in the VQI registry, 304 of whom completed the survey, including getting IAT results. Most participants (71.6%) showed a pro-White bias with 73.0% of this group in the moderate and strong categories. While 77.5% of respondents showed conscious awareness of bias, of those whose conscious results showed lack of awareness, 67.8% had moderate or strong bias, compared to 55.7% for those with awareness. Bias magnitude varied based on physician race/ethnicity and years of experience. Women were more likely than men to report awareness of biases and potential impact of bias on decision-making. Conclusions Most people have some level of unconscious bias, developed from early life reinforcements, social stereotypes, and learned experiences. Regarding health disparities, however, these are important findings in a profession that takes care of patients with PAD due to heavy burden of comorbid conditions and high proportion of individuals from structurally vulnerable groups. Given the lack of association between unconscious and conscious awareness of biases, awareness may be an important first step in mitigation to minimize racial disparities in healthcare.
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Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC
| | - Brian Witrick
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Ashley Clark
- Center for Survey Research and O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, IN
| | - Avery Morse
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Karen Atkinson
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Pranav Kapoor
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN
| | - Katharine L. McGinigle
- Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill NC
| | - Samantha Minc
- Department of Cardiovascular and Thoracic Surgery, West Virginia School of Medicine, Morgantown, WV
| | - Olamide Alabi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Gonzalez
- Department of Surgery, School of Medicine, Indiana University School of Medicine; Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute
| | - Crystal W. Cené
- Department of Medicine, University of California at San Diego Health, La Jolla, CA
| | - Samuel Cykert
- Division of General Medicine and Clinical Epidemiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill NC
| | - Corey A. Kalbaugh
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN
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Burton BN, Adeola JO, Do VM, Milam AJ, Cannesson M, Norris KC, Lopez NE, Gabriel RA. Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery. Jt Comm J Qual Patient Saf 2024; 50:416-424. [PMID: 38433070 DOI: 10.1016/j.jcjq.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models. RESULTS The final sample size was 292,797, of which 15.6% (n = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90-0.96, p < 0.001) and Asian (OR 0.76, 95% CI 0.71-0.80, p < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68-0.75, p < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (p < 0.05). CONCLUSION There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.
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Sheng H, Ma L, Samson JF, Liu D. BarlowTwins-CXR: enhancing chest X-ray abnormality localization in heterogeneous data with cross-domain self-supervised learning. BMC Med Inform Decis Mak 2024; 24:126. [PMID: 38755563 PMCID: PMC11097466 DOI: 10.1186/s12911-024-02529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Chest X-ray imaging based abnormality localization, essential in diagnosing various diseases, faces significant clinical challenges due to complex interpretations and the growing workload of radiologists. While recent advances in deep learning offer promising solutions, there is still a critical issue of domain inconsistency in cross-domain transfer learning, which hampers the efficiency and accuracy of diagnostic processes. This study aims to address the domain inconsistency problem and improve autonomic abnormality localization performance of heterogeneous chest X-ray image analysis, particularly in detecting abnormalities, by developing a self-supervised learning strategy called "BarlwoTwins-CXR". METHODS We utilized two publicly available datasets: the NIH Chest X-ray Dataset and the VinDr-CXR. The BarlowTwins-CXR approach was conducted in a two-stage training process. Initially, self-supervised pre-training was performed using an adjusted Barlow Twins algorithm on the NIH dataset with a Resnet50 backbone pre-trained on ImageNet. This was followed by supervised fine-tuning on the VinDr-CXR dataset using Faster R-CNN with Feature Pyramid Network (FPN). The study employed mean Average Precision (mAP) at an Intersection over Union (IoU) of 50% and Area Under the Curve (AUC) for performance evaluation. RESULTS Our experiments showed a significant improvement in model performance with BarlowTwins-CXR. The approach achieved a 3% increase in mAP50 accuracy compared to traditional ImageNet pre-trained models. In addition, the Ablation CAM method revealed enhanced precision in localizing chest abnormalities. The study involved 112,120 images from the NIH dataset and 18,000 images from the VinDr-CXR dataset, indicating robust training and testing samples. CONCLUSION BarlowTwins-CXR significantly enhances the efficiency and accuracy of chest X-ray image-based abnormality localization, outperforming traditional transfer learning methods and effectively overcoming domain inconsistency in cross-domain scenarios. Our experiment results demonstrate the potential of using self-supervised learning to improve the generalizability of models in medical settings with limited amounts of heterogeneous data. This approach can be instrumental in aiding radiologists, particularly in high-workload environments, offering a promising direction for future AI-driven healthcare solutions.
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Affiliation(s)
- Haoyue Sheng
- Département d'informatique et de recherche opérationnelle, Université de Montréal, 2920 chemin de la Tour, Montréal, H3T 1J4, QC, Canada.
- Mila - Quebec AI Institute, 6666 Rue Saint-Urbain, Montréal, H2S 3H1, QC, Canada.
- Direction des ressources informationnelles, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 400 Blvd. De Maisonneuve Ouest, Montréal, H3A 1L4, QC, Canada.
| | - Linrui Ma
- Département d'informatique et de recherche opérationnelle, Université de Montréal, 2920 chemin de la Tour, Montréal, H3T 1J4, QC, Canada
- Mila - Quebec AI Institute, 6666 Rue Saint-Urbain, Montréal, H2S 3H1, QC, Canada
| | - Jean-François Samson
- Direction des ressources informationnelles, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 400 Blvd. De Maisonneuve Ouest, Montréal, H3A 1L4, QC, Canada
| | - Dianbo Liu
- Mila - Quebec AI Institute, 6666 Rue Saint-Urbain, Montréal, H2S 3H1, QC, Canada
- School of Medicine and College of Design and Engineering, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, SG, Singapore
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Davies H, Russell DA, Mees BME, Scott DJA. End of life care in vascular surgery. Br J Surg 2024; 111:znae124. [PMID: 38757906 DOI: 10.1093/bjs/znae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/23/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Henry Davies
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David A Russell
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Julian A Scott
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Afulani PA, Getahun M, Okiring J, Ogolla BA, Oboke EN, Kinyua J, Oluoch I, Odiase O, Ochiel D, Mendes WB, Ongeri L. Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention. Int J Gynaecol Obstet 2024; 165:487-506. [PMID: 38146777 PMCID: PMC11021171 DOI: 10.1002/ijgo.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To assess the impact of the Caring for Providers to Improve Patient Experience (CPIPE) intervention, which sought to improve person-centered maternal care (PCMC) by addressing two key drivers: provider stress and bias. METHODS CPIPE was successfully piloted over 6 months in two health facilities in Migori County, Kenya, in 2022. The evaluation employed a mixed-methods pretest-posttest nonequivalent control group design. Data are from surveys with 80 providers (40 intervention, 40 control) at baseline and endline and in-depth interviews with 20 intervention providers. We conducted bivariate, multivariate, and difference-in-difference analysis of quantitative data and thematic analysis of qualitative data. RESULTS In the intervention group, average knowledge scores increased from 7.8 (SD = 2.4) at baseline to 9.5 (standard deviation [SD] = 1.8) at endline for stress (P = 0.001) and from 8.9 (SD = 1.9) to 10.7 (SD = 1.7) for bias (P = 0.001). In addition, perceived stress scores decreased from 20.9 (SD = 3.9) to 18.6 (SD = 5.3) (P = 0.019) and burnout from 3.6 (SD = 1.0) to 3.0 (SD = 1.0) (P = 0.001), with no significant change in the control group. Qualitative data indicated that CPIPE had an impact at multiple levels. At the individual level, it improved provider knowledge, skills, self-efficacy, attitudes, behaviors, and experiences. At the interpersonal level, it improved provider-provider and patient-provider relationships, leading to a supportive work environment and improved PCMC. At the institutional level, it created a system of accountability for providing PCMC and nondiscriminatory care, and collective action and advocacy to address sources of stress. CONCLUSION CPIPE impacted multiple outcomes in the theory of change, leading to improvements in both provider and patient experience, including for the most vulnerable patients. These findings will contribute to global efforts to prevent burnout and promote PCMC and equity.
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Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, USA
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | | | - Osamuedeme Odiase
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Dan Ochiel
- County Health Directorate, Migori, Kenya
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Gavin JR, Rodbard HW, Battelino T, Brosius F, Ceriello A, Cosentino F, Giorgino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Prashant Nedungadi T, Parkin CG, Topsever P, Rydén L, Huey-Herng Sheu W, Standl E, Olav Vandvik P, Schnell O. Disparities in prevalence and treatment of diabetes, cardiovascular and chronic kidney diseases - Recommendations from the taskforce of the guideline workshop. Diabetes Res Clin Pract 2024; 211:111666. [PMID: 38616041 DOI: 10.1016/j.diabres.2024.111666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
There is a mounting clinical, psychosocial, and socioeconomic burden worldwide as the prevalence of diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD) continues to rise. Despite the introduction of therapeutic interventions with demonstrated efficacy to prevent the development or progression of these common chronic diseases, many individuals have limited access to these innovations due to their race/ethnicity, and/or socioeconomic status (SES). However, practical guidance to providers and healthcare systems for addressing these disparities is often lacking. In this article, we review the prevalence and impact of healthcare disparities derived from the above-mentioned chronic conditions and present broad-based recommendations for improving access to quality care and health outcomes within the most vulnerable populations.
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Affiliation(s)
- James R Gavin
- Emory University School of Medicine, Atlanta, GA, USA
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD 20852, USA.
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724-5022, USA.
| | - Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni MI 20099, Italy.
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 641 Durham Centre, Box 17969, Durham, NC 27715, USA.
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China.
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, Stuttgart 70199, Germany.
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI 53703, USA.
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA; The George Institute for Global Health and University of New South Wales, Sydney, Australia.
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, Beograd 11000, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University Pauwelsstraße 30, 52074 Aachen, Germany.
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV 89074, USA
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İçerenköy, Kayışdağı Cd. No: 32, Ataşehir/İstanbul 34752, Türkiye.
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden.
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli 350, Taiwan.
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Institute of Health and Society, University of Oslo, Lovisenberggata 17, Oslo 0456, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
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Perets O, Stagno E, Yehuda EB, McNichol M, Anthony Celi L, Rappoport N, Dorotic M. Inherent Bias in Electronic Health Records: A Scoping Review of Sources of Bias. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305594. [PMID: 38680842 PMCID: PMC11046491 DOI: 10.1101/2024.04.09.24305594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Objectives 1.1Biases inherent in electronic health records (EHRs), and therefore in medical artificial intelligence (AI) models may significantly exacerbate health inequities and challenge the adoption of ethical and responsible AI in healthcare. Biases arise from multiple sources, some of which are not as documented in the literature. Biases are encoded in how the data has been collected and labeled, by implicit and unconscious biases of clinicians, or by the tools used for data processing. These biases and their encoding in healthcare records undermine the reliability of such data and bias clinical judgments and medical outcomes. Moreover, when healthcare records are used to build data-driven solutions, the biases are further exacerbated, resulting in systems that perpetuate biases and induce healthcare disparities. This literature scoping review aims to categorize the main sources of biases inherent in EHRs. Methods 1.2We queried PubMed and Web of Science on January 19th, 2023, for peer-reviewed sources in English, published between 2016 and 2023, using the PRISMA approach to stepwise scoping of the literature. To select the papers that empirically analyze bias in EHR, from the initial yield of 430 papers, 27 duplicates were removed, and 403 studies were screened for eligibility. 196 articles were removed after the title and abstract screening, and 96 articles were excluded after the full-text review resulting in a final selection of 116 articles. Results 1.3Systematic categorizations of diverse sources of bias are scarce in the literature, while the effects of separate studies are often convoluted and methodologically contestable. Our categorization of published empirical evidence identified the six main sources of bias: a) bias arising from past clinical trials; b) data-related biases arising from missing, incomplete information or poor labeling of data; human-related bias induced by c) implicit clinician bias, d) referral and admission bias; e) diagnosis or risk disparities bias and finally, (f) biases in machinery and algorithms. Conclusions 1.4Machine learning and data-driven solutions can potentially transform healthcare delivery, but not without limitations. The core inputs in the systems (data and human factors) currently contain several sources of bias that are poorly documented and analyzed for remedies. The current evidence heavily focuses on data-related biases, while other sources are less often analyzed or anecdotal. However, these different sources of biases add to one another exponentially. Therefore, to understand the issues holistically we need to explore these diverse sources of bias. While racial biases in EHR have been often documented, other sources of biases have been less frequently investigated and documented (e.g. gender-related biases, sexual orientation discrimination, socially induced biases, and implicit, often unconscious, human-related cognitive biases). Moreover, some existing studies lack causal evidence, illustrating the different prevalences of disease across groups, which does not per se prove the causality. Our review shows that data-, human- and machine biases are prevalent in healthcare and they significantly impact healthcare outcomes and judgments and exacerbate disparities and differential treatment. Understanding how diverse biases affect AI systems and recommendations is critical. We suggest that researchers and medical personnel should develop safeguards and adopt data-driven solutions with a "bias-in-mind" approach. More empirical evidence is needed to tease out the effects of different sources of bias on health outcomes.
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Rangrass G, Obiyo L, Bradley AS, Brooks A, Estime SR. Closing the gap: Perioperative health care disparities and patient safety interventions. Int Anesthesiol Clin 2024; 62:41-47. [PMID: 38385481 DOI: 10.1097/aia.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Govind Rangrass
- Department of Anesthesiology and Critical Care, Saint Louis University Hospital/SSM Health, Saint Louis, Missouri
| | - Leziga Obiyo
- Department of Anesthesia & Critical Care, University of Chicago Medicine, Chicago, Illinois
| | - Anthony S Bradley
- Department of Anesthesiology, University of South Florida Moffitt Cancer Center, Tampa, Florida
| | - Amber Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Stephen R Estime
- Department of Anesthesia & Critical Care, University of Chicago Medicine, Chicago, Illinois
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Sarfraz Z, Sarfraz A, Mehak O, Akhund R, Bano S, Aftab H. Racial and socioeconomic disparities in triple-negative breast cancer treatment. Expert Rev Anticancer Ther 2024; 24:107-116. [PMID: 38436305 DOI: 10.1080/14737140.2024.2326575] [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: 08/09/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Triple-negative breast cancer (TNBC) continues to be a significant concern, especially among minority populations, where treatment disparities are notably pronounced. Addressing these disparities, especially among African American women and other minorities, is crucial for ensuring equitable healthcare. AREAS COVERED This review delves into the continuum of TNBC treatment, noting that the standard of care, previously restricted to chemotherapy, has now expanded due to emerging clinical trial results. With advances like PARP inhibitors, immunotherapy, and antibody-drug conjugates, a more personalized treatment approach is on the horizon. The review highlights innovative interventions tailored for minorities, such as utilizing technology like text messaging, smartphone apps, and targeted radio programming, coupled with church-based behavioral interventions. EXPERT OPINION Addressing TNBC treatment disparities demands a multifaceted approach, blending advanced medical treatments with culturally sensitive community outreach. The potential of technology, especially in the realm of promoting health awareness, is yet to be fully harnessed. As the field progresses, understanding and integrating the socio-economic, biological, and access-related challenges faced by minorities will be pivotal for achieving health equity in TNBC care.
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Affiliation(s)
- Zouina Sarfraz
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Onaiza Mehak
- Department of Medicine, Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan
| | - Ramsha Akhund
- Department of Surgery, University of Alabama at Birmingham, Tuscaloosa, AL, USA
| | - Shehar Bano
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Hinna Aftab
- Department of Medicine, CMH Lahore Medical College, Lahore, Pakistan
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Reese SE, Dang A, Liddell JL. "'We'd Just Patch Ourselves up': Preference for Holistic Approaches to Healthcare and Traditional Medicine among Members of a State-Recognized Tribe". J Holist Nurs 2024; 42:34-48. [PMID: 37097906 PMCID: PMC11104771 DOI: 10.1177/08980101231169867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background:Health disparities between Native Americans and white Americans persist due to a variety of factors, including colonization, poverty, and racism. Racist interpersonal interactions between nurses and other healthcare providers and tribal members may also contribute to reluctance among Native Americans to engage with Western healthcare systems. Purpose: The purpose of this study was to better understand the healthcare experiences of members of a state-recognized Gulf Coast tribe. Methods: In partnership with a community advisory board, 31 semistructured interviews were conducted, transcribed, and analyzed utilizing a qualitative description approach. Results: All participants mentioned their preferences, views about, or experiences of using natural or traditional medicine approaches (referenced 65 times). Emergent themes include (a) preference for and use of traditional medicine; (b) resistance to western healthcare systems; (c) preference for holistic approaches to health; and (d) negative provider interpersonal interactions contributing to reluctance in seeking care. Conclusion: These findings suggest that integrating a holistic conceptualization of health and traditional medicine practices into Western healthcare settings would benefit Native Americans.
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Affiliation(s)
- Sarah E Reese
- University of Montana School of Social Work, Missoula, MT, USA
| | - Angie Dang
- Independent Researcher, New York City, USA
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Nedjat S, Wang Y, Eshtiaghi K, Fleming M. Is there a disparity in medications for opioid use disorder based on race/ethnicity and gender? A systematic review and meta-analysis. Res Social Adm Pharm 2024; 20:236-245. [PMID: 38101952 DOI: 10.1016/j.sapharm.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Access to medications for opioid use disorder (MOUD) among racial/ethnic minorities is a growing concern. OBJECTIVES Inequalities in receiving MOUD among gender and racial/ethnic groups were examined in this systematic review. METHODS Studies were retrieved by searching various databases and reference lists of reviews and selected full texts. Adjusted Odds Ratios (AORs) comparing MOUDs among racial/ethnic minorities to Whites were extracted or estimated from their findings. Meta-analysis was performed using STATA 17. RESULTS After screening 2438 records, 19 studies were included in this review in two categories. The first category consists of 11 studies comparing receiving MOUD between different races/ethnicities and genders at the individual level. The meta-analysis regarding AORs comparing Blacks, Hispanics, Asians, Native Americans/Alaska-Natives, Hawaiians, and mixed-race patients with Whites were 0.56 (95 % CI: 0.45-0.68), 0.72 (95 % CI: 0.55-0.94), 0.85 (95 % CI: 0.72-0.99), 0.88 (95%CI: 0.73-1.04), 0.27 (95 % CI: 0.03-2.18), and 0.97 (95 % CI: 0.81-1.16), respectively. The AOR of receiving MOUD for all minorities compared to Whites was 0.70 (95 % CI: 0.61-0.80). Overall AOR comparing MOUD for females to males was 0.95 (95 % CI: 0.87-1.04). The second category of articles compared buprenorphine and methadone treatment among ethnic/racial minorities and Whites. CONCLUSIONS Compared to Whites, Blacks, Hispanics, and Asians have limited access to MOUD. The findings suggest that methadone is the predominant medication for racial/ethnic minorities, while Whites and high-income communities receive buprenorphine more. It is crucial to re-design policies to bridge the gap in access to MOUD.
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Affiliation(s)
- Saharnaz Nedjat
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Yun Wang
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Khashayar Eshtiaghi
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Marc Fleming
- Department of Pharmaceutical Economics and Policy, Chapman University School of Pharmacy, Irvine, CA, USA.
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Reese SE, Liddell JL, Mascarena L. "'You Just Want to Give me Some Medicine and be on my Way': Preferences, Beliefs, and Experiences Related to Western Medication among Members of a State-Recognized Tribe". J Holist Nurs 2024:8980101231219357. [PMID: 38419480 DOI: 10.1177/08980101231219357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background: Native American/American Indian (NA/AI) people have higher rates of chronic disease, including substance use and mental health disorders, compared to White Americans. Though pharmaceuticals can be helpful in addressing many chronic healthcare conditions, many people do not take medications as prescribed. NA/AI identity has been found to be associated with lower rates of medication adherence compared to White Americans. Purpose: The purpose of this study is to better understand NA/AI women's perceptions, beliefs, and experiences related to medication. Methods: Thirty-one semi-structured interviews were conducted with NA/AI women from a state-recognized tribe located in the Gulf South. Interviews were transcribed and analyzed using a qualitative description approach. Results: Eighteen women discussed their experiences using medications when asked about their healthcare experiences. Participants identified the following themes in their discussion of medication: (a) Cost of Medication as a Barrier; (b) Negative Side Effects of Western Medication; (c) Fear of Resistance and Dependence; (d) Preference for Traditional Medicine or None; and (e) Lack of Communication around Medications from Providers. Conclusion: Our findings support the growing call for cultural safety within medical settings and integrating NA/AI conceptualizations of health and well-being and traditional practices into western healthcare settings to better support NA/AI people.
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Garrett E, Ma C, Ochoa-Dominguez CY, Navarro S, Yoon P, Hughes Halbert C, Farias AJ. Black cancer patients navigating a health-care system of racial discrimination. J Natl Cancer Inst 2024; 116:258-263. [PMID: 37849350 PMCID: PMC10852748 DOI: 10.1093/jnci/djad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Exposure to racial discrimination may exacerbate disparities throughout the cancer care continuum. Therefore, we explored how experiences of racial discrimination in the health-care setting manifest for Black cancer patients and how it contributes to racial disparities in cancer care. METHODS This qualitative analysis used semistructured in-depth interviews with Black cancer survivors not on active treatment from May 2019 to March 2020. All interviews were audio recorded, professionally transcribed, and uploaded into Dedoose software for analysis. We identified major themes and subthemes that highlight exposure to racial discrimination and its consequences for Black cancer patients when receiving cancer care. RESULTS Participants included 18 Black cancer survivors, aged 29-88 years. Most patients experienced racial discrimination when seeking care. Participants experienced racial discrimination from their interactions with health-care staff, medical assistants, front desk staff, and health insurance administrators. Exposure to overt racial discrimination in the health-care setting was rooted in racial stereotypes and manifested through verbal insults such as physicians using phrases such as "you people." These experiences impacted the ability of the health-care delivery system to demonstrate trustworthiness. Patients noted "walking out" of their visit and not having their health issues addressed. Despite experiences with racial discrimination, patients still sought care out of necessity believing it was an inevitable part of the Black individual experience. CONCLUSION We identified that exposure to racial discrimination in the health-care setting is pervasive, affects health-seeking behaviors, and degrades the patient-clinician relationship, which may likely contribute to racial disparities in cancer care.
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Affiliation(s)
- Elleyse Garrett
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Cindy Ma
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Paul Yoon
- Keck School of Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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D'Orta I, Weber K, Herrmann FR, Giannakopoulos P. Women in acute forensic psychiatric care: comparison of clinical, sociodemographic, and detention-related characteristics in pretrial detention, sentence execution, and court-ordered treatment. BMC Psychiatry 2024; 24:94. [PMID: 38308259 PMCID: PMC10835924 DOI: 10.1186/s12888-024-05546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024] Open
Abstract
Compared to men inmates, women display decreased prevalence of severe mental disorder but increased occurrence of substance use disorders (SUD) and higher rates of previous contacts with mental health services. The group of women in detention is highly heterogeneous according to the status of incarceration (pre-trial detention (PTD), sentence execution (SE) and court ordered treatments (COT)). Studies focusing on the comparison of sociodemographic patterns, detention-related and clinical variables between these groups are still lacking. We explored these parameters in 136 women admitted for acute psychiatric care in the sole Geneva forensic unit during a nine year period (2014-2023). Sociodemographic and detention-related data included age, nationality, marital status, presence of children, education attainment, most frequently speaking language, social support, employment before conviction and type of offenses. Clinical variables included the main ICD-10 diagnosis, presence of concomitant SUD, type of personality disorders, presence of suicidal thoughts and attempts at admission, as well as number and mean duration of stays. PTD and SE women had at least 9 years of formal education in 38.9% and 30.3% of cases. Most women in PTD (77.7%), SE (56.6%) and COT (56.2%) groups were Swiss or European citizens. The level of French knowledge was excellent in most of the cases. 43.8% of COT women had at least one child and this percentage is even higher for PTD and SE cases. The employment rate before conviction was also quite high, mainly for PTD and SE (61.1% and 60.6%) and, in a lesser degree, for COT (43.8%) women. Significant social support was present in the vast majority of women without any significant group difference. The distribution of type of offenses did not differ between the three types of detention with a predominance of physical violence, and drug trafficking. The number of stays during the period of reference was significantly higher in COT compared to both SE and PTD women. History of previous inpatient care was also significantly more frequent in COT that SE and PTD women. Adjustment and affective disorders were more often found in SE and PTD cases, these diagnoses were absent in the COT group. In contrast, a main diagnosis of psychotic disorders was found in 62.5% of COT cases compared to only 21.2% in SE and 24.1% in PTD cases. The number of stays, history of inpatient care and diagnosis of psychosis were independent predictors of COT status. In conclusion, the present data reveal the good social integration and emotional support of women needing acute psychiatric care in prison independently of the type of detention. Clinically, women in PTD and SE display more often emotional distress whereas those in COT suffer from acute psychotic symptoms with previous history of psychiatric care and multiple inpatient stays.
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Affiliation(s)
- Isabella D'Orta
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland.
- Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Kerstin Weber
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Urbanski M, Lee YTH, Escoffery C, Buford J, Plantinga L, Pastan SO, Hamoda R, Blythe E, Patzer RE. Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access. Kidney Int Rep 2024; 9:225-238. [PMID: 38344743 PMCID: PMC10851002 DOI: 10.1016/j.ekir.2023.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction The Allocation System for changes in Equity in Kidney Transplantation (ASCENT) study was a hybrid type 1 trial of a multicomponent intervention among 655 US dialysis facilities with low kidney transplant waitlisting to educate staff and patients about kidney allocation system (KAS) changes and increase access to and reduce racial disparities in waitlisting. Intervention components included a staff webinar, patient and staff educational videos, and facility-specific feedback reports. Methods Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework. Postimplementation surveys were administered among intervention group facilities (n = 334); interviews were conducted with facility staff (n = 6). High implementation was defined as using 3 to 4 intervention components, low implementation as using 1 to 2 components, and nonimplementation as using no components. Results A total of 331 (99%) facilities completed the survey; 57% were high implementers, 31% were low implementers, and 12% were nonimplementers. Waitlisting events were higher or similar among high versus low implementer facilities for incident and prevalent populations; for Black incident patients, the mean proportion waitlisted in low implementer facilities was 0.80% (95% confidence interval [CI]: 0.73-0.87) at baseline and 0.55% at 1-year (95% CI: 0.48-0.62) versus 0.83% (95% CI: 0.78-0.88) at baseline and 1.40% at 1-year (95% CI: 1.35-1.45) in high implementer facilities. Interviews revealed that the intervention helped facilities prioritize transplant education, but that intervention components were not uniformly shared. Conclusion The findings provide important context to interpret ASCENT effectiveness results and identified key barriers and facilitators to consider for future modification and scale-up of multilevel, multicomponent interventions in dialysis settings.
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Affiliation(s)
- Megan Urbanski
- Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
- Health Services Research Center, Emory University, Atlanta, Georgia, USA
| | - Yi-Ting Hana Lee
- Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jade Buford
- Regenstrief Institute, Indianapolis, Indiana, USA
| | - Laura Plantinga
- University of California San Francisco, Department of Medicine, Divisions of Rheumatology and Nephology, San Francisco, California, USA
| | - Stephen O. Pastan
- Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Reem Hamoda
- Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emma Blythe
- Health Services Research Center, Emory University, Atlanta, Georgia, USA
| | - Rachel E. Patzer
- Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
- Regenstrief Institute, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana, USA
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Doyle AJ, Sullivan C, O'Toole M, Tjin A, Simiceva A, Collins N, Murphy P, Anderson MJ, Mulhall C, Condron C, Nestel D, MacAulay R, McNaughton N, Coffey F, Eppich W. Training simulated participants for role portrayal and feedback practices in communication skills training: A BEME scoping review: BEME Guide No. 86. MEDICAL TEACHER 2024; 46:162-178. [PMID: 37552799 DOI: 10.1080/0142159x.2023.2241621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. METHODS The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). RESULTS From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. CONCLUSIONS The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.
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Affiliation(s)
- Andrea J Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- Department of Visual & Human Centred Computing, Dundalk Institute of Technology, Co. Louth
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin Ireland
| | - Michael J Anderson
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Debra Nestel
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
- Department of Surgery, University of Melbourne, Australia
| | - Robert MacAulay
- School of Medicine, University of California San Diego, United States of America
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Frank Coffey
- DREEAM (Department of Research and Education in Emergency and Acute medicine, Nottingham University Hospitals' NHS Trust)
- School of Health Sciences, University of Nottingham, UK
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Aijaz M, Lewis VA, Murray GF. Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient-provider relationships in primary care settings during the COVID-19 pandemic. Digit Health 2024; 10:20552076241233148. [PMID: 38434791 PMCID: PMC10906055 DOI: 10.1177/20552076241233148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The patient-provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient-provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient-provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient-provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient-provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient-provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization.
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Affiliation(s)
- Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevra F Murray
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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28
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Wizentier MM, Stephenson BJK, Goodman MS. The measurement of racism in health inequities research. Epidemiol Rev 2023; 45:32-43. [PMID: 37147182 DOI: 10.1093/epirev/mxad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.
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Affiliation(s)
- Marina Mautner Wizentier
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
| | - Briana Joy K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Melody S Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
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Hutchens K. "It Wasn't Very Public-Clinicy": Client Experiences at Faith-Based Pregnancy Centers. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:486-502. [PMID: 37222523 DOI: 10.1177/00221465231171555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Faith-based pregnancy centers strive to offer "alternatives to abortion" that supporters claim aid women and critics assert manipulate pregnant people, stigmatize abortion, and potentially delay clients from obtaining medical care. However, scholars know little about the exchanges within appointments and how clients make sense of these experiences. Drawing on ethnographic observations of client appointments in two pregnancy centers in the West and 29 in-depth interviews with clients, this article uses an intersectional framework to analyze client experiences. Clients favorably compared centers to clinical health care providers, emphasizing the unexpectedly attentive emotional care they received. These evaluations stem from clients' reproductive histories, which are shaped by gender, racism, and economic inequalities that configure their access to and interactions within the health system. Emotional care serves to create and maintain pregnancy centers' impression of legitimacy among clients.
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Hancock H, Carlson O, Hempstone H, Arnold B, Hoffmann K, Gul X, Spielman K. Six Recommendations for Provider Behavior Change in Family Planning. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200495. [PMID: 38035718 PMCID: PMC10698237 DOI: 10.9745/ghsp-d-22-00495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/21/2023] [Indexed: 12/02/2023]
Abstract
Health care provider behavior has the power to influence family planning and reproductive health outcomes positively and negatively, underlining the importance of provider behavior change (PBC) initiatives. However, global health practitioners lack a shared understanding of PBC interventions and what influences provider behavior. Furthermore, PBC interventions in family planning and reproductive health have tended to address individual and workplace environmental factors rather than the full breadth of factors that influence provider behavior, including the broader systems and contexts where providers operate. This commentary contributes to a common understanding of PBC, including the determinants of provider behavior, and describes actions to advance PBC efforts in family planning and reproductive health. To inform these considerations, we conducted a narrative review of more than 70 articles and project materials describing interventions that aimed to change provider behaviors pertaining to family planning and reproductive health and used the review to identify the most and least common provider cadres addressed, behavioral determinants targeted, and strategies implemented. We strongly encourage global health practitioners to design future PBC interventions for a more diverse set of cadres and contexts, consider the full set of factors that influence provider behavior, pair provider- and client-side interventions, shift the narrative around PBC from "blaming" to supporting providers, move beyond training-only interventions, and improve the rigor of measurement and evidence-building efforts for PBC. These considerations can be used to advance the field of PBC in family planning and reproductive health to improve outcomes across the service delivery continuum.
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Affiliation(s)
- Heather Hancock
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Olivia Carlson
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | | | | | - Kamden Hoffmann
- USAID/MOMENTUM Integrated Health Resilience, IMA World Health, Washington, DC, USA
| | - Xaher Gul
- Pathfinder International, Watertown, MA, USA
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Owusu-Ansah S, Crowe RP, Ramgopal S. Racial, Ethnic, and Socioeconomic Disparities in Prehospital Encounters for Children with Asthma. PREHOSP EMERG CARE 2023; 27:1107-1114. [PMID: 37748188 DOI: 10.1080/10903127.2023.2260471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Asthma represents one of the most common medical conditions among children encountered by emergency medical services (EMS). While care disparities for children with asthma have been observed in other healthcare settings, limited data exist characterizing disparities in prehospital care. We sought to characterize differences in prehospital treatment and transport of children with suspected asthma exacerbations by race and ethnicity, within the context of community socioeconomic status. METHODS We conducted a multi-agency retrospective study of EMS encounters in 2019 for children (2-17 years) with asthma and wheezing using a national prehospital database. Our primary outcomes included EMS transport and prehospital bronchodilator or systemic corticosteroid administration. Scene socioeconomic status was evaluated using the social vulnerability index. We used generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for prehospital bronchodilator use or steroid use by race and ethnicity, adjusting for age, presence of abnormal vital signs, community size, bronchodilator use prior to EMS arrival, and transport disposition. RESULTS We analyzed 5,266 EMS encounters (median age 8 years). Approximately half (53%) were Black non-Hispanic and 34% were White non-Hispanic. Overall, 77% were transported by EMS. In an adjusted model, Black non-Hispanic children were 25% less likely to be transported compared to White non-Hispanic children (aOR: 0.75, 95%CI: 0.58-0.96). EMS administered at least one bronchodilator to 81% of Black non-Hispanic patients, 73% of Hispanic patients, and 68% of White, non-Hispanic patients. Relative to White non-Hispanic children, EMS bronchodilator administration was greater for Black non-Hispanic children, (aOR: 1.55, 95%CI: 1.25-1.93), after controlling for scene socioeconomic status and potential confounding variables. Systemic corticosteroids were administered in 3% of all encounters. Odds of prehospital systemic corticosteroid administration did not differ significantly by race and ethnicity. CONCLUSION Black non-Hispanic children comprised a larger proportion of EMS encounters for asthma and were more likely to receive a bronchodilator in adjusted analyses accounting for community socioeconomic status. However, these children were less likely to be transported by EMS. These findings may reflect disease severity not manifested by abnormal vital signs, management, and other social factors that warrant further investigation.
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Affiliation(s)
- Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Muhammad T, Pai M. Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators. Aging Clin Exp Res 2023; 35:2517-2530. [PMID: 37642931 DOI: 10.1007/s40520-023-02531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment. METHODS Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions. RESULTS The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment. CONCLUSIONS Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.
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Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
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Dore S, Weleff J, Anand A, Thompson NR, Barnett BS. Race, economic status, and disparities in the receipt of benzodiazepine prescriptions in a large primary care sample. Gen Hosp Psychiatry 2023; 85:28-34. [PMID: 37729721 DOI: 10.1016/j.genhosppsych.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To evaluate the relationship between race, economic status, and patient characteristics with benzodiazepine prescribing in an urban and suburban primary care context. METHOD This retrospective study used data from a previously described cohort of patients seen in a large Ohio healthcare system's primary care clinics from 2019 to 2020. Associations and interactions between race, economic status (using median income of patient ZIP code as a proxy), patient characteristics, and prescription of benzodiazepines were assessed using multivariable logistic regression. RESULTS 455,537 patients had 1,643,473 primary care visits, and 5.8% of patients were prescribed a benzodiazepine. White patients were prescribed benzodiazepines more often than Multiracial/Multicultural, African American and Asian American patients (6.5%, 3.8%, 2.7% and 2.0% respectively). Patients from lower income ZIP codes were less likely to receive a prescription. Interaction effects were observed between race, patient economic status, gender, insurance status, and diagnoses (general anxiety disorder, insomnia, and panic disorder). The largest prescribing disparities by race were among patients with these three diagnoses. The largest disparity in prescription by income was seen in African American patients. CONCLUSION African American, Multicultural/Multiracial and Asian American patients were less likely than White patients to receive benzodiazepine prescriptions. Middle and lower-income patients are particularly susceptible to this prescribing disparity.
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Affiliation(s)
- Samyukta Dore
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA.
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Akhil Anand
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA; Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Neurological Institute, Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, USA
| | - Brian S Barnett
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA; Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Hagiwara N, Harika N, Carmany EP, Shin Y, Eggly S, Jones SCT, Quillin J. Racial disparities in cancer genetic counseling encounters: study protocol for investigating patient-genetic counselor communication in the naturalistic clinical setting using a convergent mixed methods design. BMC Cancer 2023; 23:983. [PMID: 37845629 PMCID: PMC10578042 DOI: 10.1186/s12885-023-11486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Despite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers' implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers' explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients. METHODS Using a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses. DISCUSSION Findings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.
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Affiliation(s)
- Nao Hagiwara
- Department of Public Health Sciences, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Nadia Harika
- Department of Pediatrics, Virginia Commonwealth University, 1008 East Clay Street, B-011 Box 980270, Richmond, VA, 23219, USA
| | - Erin P Carmany
- Center for Molecular Medicine and Genetics, Wayne State University, 3127 Scott Hall, 540 E. Canfield Ave, Detroit, MI, 48201, USA
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, One Capitol Square 718, Richmond, VA, 23298, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University, Karmanos Cancer Institute, 4100 John R, Detroit, MI, 48201, USA
| | - Shawn C T Jones
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, 23284, Richmond, VA, USA
| | - John Quillin
- Department of Pediatrics, Virginia Commonwealth University, 1008 East Clay Street, B-011 Box 980270, Richmond, VA, 23219, USA
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Lorusso L, Bacchini F. The indispensability of race in medicine. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:421-434. [PMID: 37040059 PMCID: PMC10088754 DOI: 10.1007/s11017-023-09622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 06/19/2023]
Abstract
A movement asking to take race out of medicine is growing in the US. While we agree with the necessity to get rid of flawed assumptions about biological race that pervade automatic race correction in medical algorithms, we urge caution about insisting on a blanket eliminativism about race in medicine. If we look at racism as a fundamental cause, in the sense that this notion has been introduced in epidemiological studies by Bruce Link and Jo Phelan, we must conclude that race is indispensable to consider, investigate, and denounce the health effects of multilevel racism, and cannot be eliminated by addressing more specific risk factors in socially responsible epidemiology and clinical medicine. This does not mean that realism about human races is vindicated. While maintaining that there are no human races, we show how it is that a non-referring concept can nonetheless turn out indispensable for explaining real phenomena.
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Affiliation(s)
- Ludovica Lorusso
- Department of Social Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fabio Bacchini
- Laboratory of Applied Epistemology, DADU, University of Sassari, Alghero, Italy
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Schouten BC, Manthey L, Scarvaglieri C. Teaching intercultural communication skills in healthcare to improve care for culturally and linguistically diverse patients. PATIENT EDUCATION AND COUNSELING 2023; 115:107890. [PMID: 37437511 DOI: 10.1016/j.pec.2023.107890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To provide recommendations for adequately training healthcare providers in intercultural communication skills. DISCUSSION We discuss three main recommendations concerning intercultural communication skills training. First, we give an overview of the fundamental skills in which healthcare providers should receive training, such as self-awareness and adaptability. Second, we briefly discuss how such training should be delivered, and focus on different language support methods, including those that work with different types of interpreters and digital tools. Third, we discuss how within-group differences can be taken into account to prevent stereotyping. To illustrate these recommendations, we provide certain examples of existing good practices and interventions. CONCLUSION In today's superdiverse societies, delivering culturally and linguistically sensitive healthcare tailored to the needs, values, and preferences of individual patients is a prerequisite for good quality healthcare communication. To achieve this goal, there is a need for clearer recommendations for affirmative action, guidelines, policy, and support for the topic of diversity sensitivity in healthcare, such as evidence-based interventions, than is currently the case. That is, structural changes on a system level are urgently needed to support healthcare providers to implement diversity sensitivity in their daily clinical work.
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Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Linn Manthey
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Claudio Scarvaglieri
- Institute of German Language and Literature, University of Lausanne, Switzerland
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Dodd RV, Rafi D, Stackhouse AA, Brown CA, Westacott RJ, Meeran K, Hughes E, Wilkinson P, Gurnell M, Swales C, Sam AH. The impact of patient skin colour on diagnostic ability and confidence of medical students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1171-1189. [PMID: 36859731 PMCID: PMC9977083 DOI: 10.1007/s10459-022-10196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/11/2022] [Indexed: 06/18/2023]
Abstract
Previous literature has explored unconscious racial biases in clinical education and medicine, finding that people with darker skin tones can be underrepresented in learning resources and managed differently in a clinical setting. This study aimed to examine whether patient skin colour can affect the diagnostic ability and confidence of medical students, and their cognitive reasoning processes. We presented students with 12 different clinical presentations on both white skin (WS) and non-white skin (NWS). A think aloud (TA) study was conducted to explore students' cognitive reasoning processes (n = 8). An online quiz was also conducted where students submitted a diagnosis and confidence level for each clinical presentation (n = 185). In the TA interviews, students used similar levels of information gathering and analytical reasoning for each skin type but appeared to display increased uncertainty and reduced non-analytical reasoning methods for the NWS images compared to the WS images. In the online quiz, students were significantly more likely to accurately diagnose five of the 12 clinical presentations (shingles, cellulitis, Lyme disease, eczema and meningococcal disease) on WS compared to NWS (p < 0.01). With regards to students' confidence, they were significantly more confident diagnosing eight of the 12 clinical presentations (shingles, cellulitis, Lyme disease, eczema, meningococcal disease, urticaria, chickenpox and Kawasaki disease) on WS when compared to NWS (p < 0.01). These findings highlight the need to improve teaching resources to include a greater diversity of skin colours exhibiting clinical signs, to improve students' knowledge and confidence, and ultimately, to avoid patients being misdiagnosed due to the colour of their skin.
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Affiliation(s)
- Rebecca V Dodd
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | - Damir Rafi
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | - Ashlyn A Stackhouse
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | - Celia A Brown
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rachel J Westacott
- Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Karim Meeran
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | | | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mark Gurnell
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Catherine Swales
- Oxford University Medical School, University of Oxford, Oxford, United Kingdom
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, United Kingdom.
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Armstrong-Mensah E, Rasheed N, Williams D, Moyer K, Alema-Mensah E, Tetteh AK. Implicit Racial Bias, Health Care Provider Attitudes, and Perceptions of Health Care Quality Among African American College Students in Georgia, USA. J Racial Ethn Health Disparities 2023; 10:2600-2612. [PMID: 36331715 DOI: 10.1007/s40615-022-01439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Due to racism, over 20% of African Americans, including college students in Georgia, receive poor quality health care. Consequently, most students are reluctant to utilize health care services in the state. This study examined biased racial attitudes of health care providers in Georgia, and African American Georgia State University (GSU) School of Public Health (SPH) students' perceptions of the quality of health care they receive from providers, the effects of such care, and student recommendations for the way forward. DESIGN A mixed-methods cross-sectional design was used to collect data from 63 students across six domains using Qualtrics. RESULTS Provider brushes off patient concerns when providing medical care (29.9%), stereotyping (26.9%), and the lack of communication during medical care (25.4%) were the three main implicit racial attitudes identified by GSU SPH students. Owing to the poor quality of care they receive from their health care providers, some students (28.4%) are reluctant to utilize health care services, distrust doctors that are not from their race (34.3%), do not adhere to treatment (19.4%), and prefer to use home remedies (28.4%) when ill. Students recommended cultural competency training, holding health care providers accountable for their actions, and increasing African American health care providers in Georgia as ways to address health care provider attitudes and quality of care. CONCLUSION Negative provider attitudes impact the health and health-seeking behavior of African American college students in Georgia. These attitudes must be eliminated so barriers to clinical participation are removed, and student health outcomes optimized.
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Affiliation(s)
- Elizabeth Armstrong-Mensah
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA.
| | - Nina Rasheed
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA
| | - Darylisha Williams
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA
| | - Keianna Moyer
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA
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Williams JC, Andreou A, Castillo EG, Neff J, Goldenberg M, Lee CR, Aysola J, Rohrbaugh R, Isom J. Antiracist Documentation Practices - Shaping Clinical Encounters and Decision Making. N Engl J Med 2023; 389:1238-1244. [PMID: 37754291 PMCID: PMC10617745 DOI: 10.1056/nejmms2303340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- J Corey Williams
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Ashley Andreou
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Enrico G Castillo
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Joshua Neff
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Matthew Goldenberg
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Courtney R Lee
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Jaya Aysola
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Robert Rohrbaugh
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
| | - Jessica Isom
- From the Department of Psychiatry, Georgetown University, Washington, DC (J.C.W.); the Department of Psychiatry, Yale University, New Haven, CT (J.C.W., M.G., R.R.); the Department of Psychiatry, Columbia University, New York (A.A.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (E.G.C.); the Department of Psychiatry, University of California, San Francisco, San Francisco (J.N.); the Leonard Davis Institute of Health Economics (C.R.L.) and the Department of Medicine, Perelman School of Medicine (J.A.), University of Pennsylvania, Philadelphia; and the Department of Behavioral Health, Codman Square Health Center, Boston (J.I.)
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Rajahraman V, Lawrence KW, Berzolla E, Lajam CM, Schwarzkopf R, Rozell JC. The Benefit in Patient-Reported Outcomes After Total Knee Arthroplasty was Comparable Across Income Quartiles. J Arthroplasty 2023; 38:1652-1657. [PMID: 36963532 DOI: 10.1016/j.arth.2023.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Few studies have assessed how socioeconomic status (SES) influences patient-reported outcomes (PROMs) after total knee arthroplasty (TKA). This study evaluated the impact of patient median ZIP code income levels on PROMs after TKA. METHODS We retrospectively reviewed patients at our institution undergoing primary, unilateral TKA from 2017 to 2020. Patients who did not have one-year postoperative PROMs were excluded. Patients were stratified based on the quartile of their home ZIP code median income from United States Census Bureau data. There were 1,267 patients included: 98 in quartile 1 (median income ≤ $46,308) (7.7%); 126 in quartile 2 (median income $46,309-$57,848) (10.0%); 194 in quartile 3 (median income $57,849-$74,011) (15.7%); and 849 in quartile 4 (median income ≥ $74,012) (66.4%). We collected baseline demographic data, 2-year outcomes, and PROMs preoperatively, as well as at 12 weeks and one year, postoperatively. RESULTS The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was significantly higher in quartile 4 preoperatively (P < .001), 12 weeks postoperatively (P < .001), and one year postoperatively (P < .001). There were no significant differences in delta improvements of Knee Injury and Osteoarthritis Outcome Score for Joint Replacement from preoperative to 12 weeks or one year postoperatively. There were no significant differences in lengths of stay, discharge dispositions, readmissions, or revisions. CONCLUSION Patients from lower income areas have slightly worse knee function preoperatively and worse outcomes following TKA. However, improvements in PROMs throughout the first year postoperatively are similar across income quartiles, suggesting that patients from lower income quartiles achieve comparable therapeutic benefits from TKA. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Vinaya Rajahraman
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Emily Berzolla
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Claudette M Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Reddy KP, Faggioni M, Eberly LA, Halaby R, Sanghavi M, Lewey J, Mehran R, Coylewright M, Herrmann HC, Giri J, Fanaroff AC, Nathan AS. Enrollment of Older Patients, Women, and Racial and Ethnic Minority Individuals in Valvular Heart Disease Clinical Trials: A Systematic Review. JAMA Cardiol 2023; 8:871-878. [PMID: 37494015 DOI: 10.1001/jamacardio.2023.2098] [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: 07/27/2023]
Abstract
Importance Inadequate representation of older patients, women, and racial minority individuals in cardiovascular clinical trials limits both the generalizability of trial findings and inclusivity in access to novel therapies and therapeutic strategies. Objective To report on temporal trends in the representation of older patients, women, and racial and ethnic minority individuals in clinical trials studying treatments for valvular heart disease. Evidence Review All published clinical trials enrolling more than 100 adults with any valvular heart disease published between 2005 and 2020 were included after searches with PubMed and ClinicalTrials.gov. Data on age, sex, race, and ethnicity reported in the included studies were collected. Trials were assigned to 4 time periods based on the publication date, and temporal trends were analyzed in the representation of older patients, women, and racial and ethnic minority individuals. Findings A total of 139 clinical trials with 51 527 participants were identified. Of these trials, 103 (74%) investigated aortic valve disease and the remainder mitral valve disease. Overall, 63 trials (45.3%) enrolled patients only in Europe, 24 (17.3%) only in North America, and 19 (13.7%) in multiple geographical regions. The weighted mean (SD) age of enrolled patients was 68.4 (11.4) years, increasing nonsignificantly from 61.9 (5.9) years in 2005-2008 to 72.8 (9.6) years in 2017-2020 (P = .09 for trend). The overall proportion of women enrolled in valvular heart disease trials was 41.1%, with no significant changes over time. Data on race and ethnicity of trial participants were reported in 13 trials (9.4%), in which trial-level representation of American Indian/Alaska Native, Asian, Black/African American, Hispanic, and Native Hawaiian/Pacific Islander patients ranged from 0.27% to 43.9%. There were no significant temporal trends noted in the enrollment of racial and ethnic minority populations. The representation of women in clinical trials was positively associated with enrollment rates of older patients and underrepresented racial and ethnic groups. Conclusions and Relevance This review found that over the past 2 decades, women and racial and ethnic minority individuals have remained underrepresented in North American valvular heart disease clinical trials. Further work is needed to improve the reporting of race and ethnicity data and address barriers to trial enrollment for older patients, women, and racial and ethnic minority individuals.
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Affiliation(s)
- Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
| | - Michela Faggioni
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Lauren A Eberly
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Rim Halaby
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Monika Sanghavi
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jennifer Lewey
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
- Associate Editor, JAMA Cardiology
| | | | - Howard C Herrmann
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Kosoko AA, Alford YR, Upplegger KA, Stevens GS. Not Just a Pain: A Medical Simulation Case About Biased Communication and Osteomyelitis in Pediatric Sickle Cell Anemia. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11335. [PMID: 37593566 PMCID: PMC10427742 DOI: 10.15766/mep_2374-8265.11335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/01/2023] [Indexed: 08/19/2023]
Abstract
Introduction Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced similarly to the optimal management of the complex medical conditions associated with sickle cell disease (SCD). This simulation is designed to teach about biases, optimizing communication to and about a patient with SCD, and appropriately diagnosing and managing pediatric osteomyelitis as a complication of SCD. Methods We designed and implemented a simulation case targeting emergency medicine residents and fellows to raise awareness about biases associated with SCD care and the complication of osteomyelitis in children with SCD. The case was delivered as a scheduled educational activity. Guided debriefing about optimizing care and communication for this patient population followed the simulation. We measured outcomes based on facilitator field notes and participant evaluations (Likert-scale and open-response questions). Results Forty learners of varying medical practice proficiencies, societal experiences, and demographics participated, with 30 completing the postsimulation feedback survey. A majority (97%) of participants indicated that the experience was useful and would improve their clinical performance. Participants learned from each other's language and communication styles and reflected on their own communication. Discussion Overall, participants found the simulation very useful as a review of the medical diagnosis and management of osteomyelitis in pediatric SCD. Moreover, they were very engaged and interested in the opportunity to learn about communication biases, particularly as these relate to SCD, to optimize their patient care.
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Affiliation(s)
- Adeola A. Kosoko
- Assistant Professor, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Yakira R. Alford
- Third-Year Resident, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Karl A. Upplegger
- Pediatric Emergency Medicine Fellow, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Gowri S. Stevens
- Assistant Professor, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
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43
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Morgan J, Wagoner JA, Pyszczynski T. Psychosocial Determinants of COVID-19 Vaccine Hesitancy and the Mediating Role of Various Attitudes towards Science. Vaccines (Basel) 2023; 11:1310. [PMID: 37631878 PMCID: PMC10459256 DOI: 10.3390/vaccines11081310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
This study examined the way attitudes towards science in the U.S. mediate the relationship between COVID-19 vaccine hesitancy and psychosocial predictors, such as political ideology, religiosity, reactance proneness, dogmatism, perceived communal ostracism, education, and socioeconomic status. We analyzed the structure of people's attitudes towards science, revealing four distinct factors: epistemic confidence, belief that science and technology are beneficial, trust in science in general, and trust in medical science. With all four factors included as mediators in a saturated path analysis, low levels of trust in medical science and low epistemic confidence fully mediated the relationships between nearly all of the psychosocial predictors and COVID-19 vaccine hesitancy. Political conservativism's negative association with vaccine hesitancy was partially mediated by the same two facets of people's attitudes towards science. Adding nuance to existing research, we found that trust in science in general was not a significant mediator once all four facets were included in the model. These findings are discussed with a focus on their implications for understanding attitudes towards science and their substantial and complex role in COVID-19 vaccine hesitancy.
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Affiliation(s)
- Jonathan Morgan
- Psychology Department, University of Colorado, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80919, USA (T.P.)
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44
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Harris S, Narayanan NS, Tranel D. Does Black vs. White race affect practitioners' appraisal of Parkinson's disease? NPJ Parkinsons Dis 2023; 9:106. [PMID: 37419894 DOI: 10.1038/s41531-023-00549-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Abstract
Black patients are diagnosed with Parkinson's disease (PD) at half the rate as White patients. The reasons for this large disparity are unknown. Here, we review evidence that practitioner bias may contribute. A key sign of PD is hypomimia or decreased facial expressivity. However, practitioner bias surrounding facial expressivity in Black people versus White people may lead practitioners to appraise Black patients with hypomimia as having higher levels of facial expressivity. Furthermore, practitioner bias may cause them to characterize reduced facial expressivity as being due to negative personality traits, as opposed to a medical sign, in Black patients with hypomimia. This racial bias in the evaluation of hypomimia in Black versus White patients could profoundly impact subsequent referral decisions and rates of diagnosis of PD. Therefore, exploring these differences is expected to facilitate addressing health care disparities through earlier and more accurate detection of PD in Black patients.
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Affiliation(s)
- Shana Harris
- Department of Neurology (Division of Neuropsychology and Cognitive Neuroscience), University of Iowa, Iowa City, IA, USA.
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Nandakumar S Narayanan
- Departments of Neurology (Division of Neuroscience), University of Iowa, Iowa City, IA, USA
| | - Daniel Tranel
- Department of Neurology (Division of Neuropsychology and Cognitive Neuroscience), University of Iowa, Iowa City, IA, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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45
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Smith AJB, Alvarez R, Heintz J, Simpkins F, Ko EM. Disparities in clinical trial participation in ovarian cancer: A real-world analysis. Gynecol Oncol 2023; 175:25-31. [PMID: 37300995 DOI: 10.1016/j.ygyno.2023.05.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Significant disparities exist in clinical trial participation in non-gynecologic cancers, but little is known about disparities in ovarian cancer trial participation. Our objective was to examine patient, sociodemographic (race/ethnicity, insurance), cancer, and health system factors associated with clinical trial participation in ovarian cancer. METHODS We conducted a retrospective cohort study of patients with epithelial ovarian cancer diagnosed from 2011 to 2021, using a real-world electronic health record derived database, representing around 800 sites of care in US academic and community practices. We used multivariable Poisson regression modeling to analyze the association of ever participating in an ovarian cancer clinical drug trial with patient, sociodemographic, health system, and cancer factors. RESULTS Of the 7540 patients with ovarian cancer, 5.0% (95% CI 4.5-5.5) ever participated in a clinical drug trial. Patients of Hispanic or Latino ethnicity were 71% less likely to participate in clinical trials (RR 0.29, 95% CI 0.13-0.61) than non-Hispanic patients, and patients whose race was unknown or other than Black or White were 40% less likely to participate in clinical trials (RR 0.68, 95% CI 0.52-0.89). Patients who had Medicaid insurance were 51% less likely (RR 0.49, 95% CI 0.28-0.87) and those with Medicare were 32% (RR 0.48-0.97) less likely to participate in clinical trials than privately-insured patients. CONCLUSION In this national cohort study, only 5% of patients with ovarian cancer participated in clinical drug trials. Interventions are needed to decrease race, ethnicity, and insurance disparities in clinical trial participation.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA.
| | | | - Jonathan Heintz
- Biostatistics Analysis Center, Perelman School of Medicine, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Fiona Simpkins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
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46
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Groene OR, Huelmann T, Hampe W, Emami P. German Physicians and Medical Students Do Not Represent the Population They Serve. Healthcare (Basel) 2023; 11:1662. [PMID: 37372780 DOI: 10.3390/healthcare11121662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Medical professionals who represent the communities they serve are in a better position to understand patients' social circumstances and communicate in a more patient-centered way. International studies show limited diversity and underrepresentation of certain social groups in the population of physicians and medical students. We designed an observational study to investigate the cultural and socio-economic diversity of physicians and medical applicants in comparison to the general population in Germany. We invited 15,195 physicians in Hamburg and 11,287 medical applicants in Germany to participate in an online survey between June and August 2022. The lower three quintiles of objective socio-economic background (SEB) were vastly underrepresented in all subsamples of the study and in particular amongst applicants and students admitted in Hamburg: 57.9% of physicians and 73.8% of medical students in Hamburg originate from the top quintile of SEB. The Turkish and Polish communities were particularly underrepresented in the group of physicians from Hamburg and medical applicants and students in Germany (p = 0.02; p < 0.001). In line with existing evidence, the vast majority of physicians and medical students come from the most affluent households when entering medical school. Widening participation strategies are needed to facilitate fairer access to the study of medicine in Germany.
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Affiliation(s)
- Oana R Groene
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thorben Huelmann
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Wolfgang Hampe
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Pedram Emami
- Hamburg Chamber of Physicians, 22083 Hamburg, Germany
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47
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Russell R, Fleming-Hall E, Wilson-Delfosse A, Ashby K. An Institutional Evaluation of Race and Ethnic Diversity in Pre-clerkship Lectures. MEDICAL SCIENCE EDUCATOR 2023; 33:645-651. [PMID: 37501795 PMCID: PMC10368599 DOI: 10.1007/s40670-023-01789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 07/29/2023]
Abstract
The goal of this project was to assess the current state of racial and ethnic presentation in medical pedagogy using the pre-clerkship curriculum at Case Western Reserve University School of Medicine (CWRU SOM). We systematically reviewed 20,630 slides across the basic sciences curriculum from 2020 to 2022 for references to race, ethnicity, or photos of people of color. Results showed that race and ethnicity are overwhelmingly used as biological constructs and references lack appropriate historical context. In addition, this project constructed learning objectives that provide suggestions to shift medical discourse on race and ethnicity from contemplation to a state of solution.
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Affiliation(s)
- Rebekah Russell
- Case Western Reserve University School of Medicine, Cleveland, USA
| | | | | | - Karen Ashby
- University Hospitals Cleveland, Cleveland, OH USA
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48
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Brissett DI, Davies SH, Sit L. Reimagining No-Shows as a Symptom and Not a Diagnosis: A Strength-Based, Trauma-Sensitive Approach. Pediatrics 2023:191236. [PMID: 37139705 DOI: 10.1542/peds.2022-057590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Daniela I Brissett
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Shelby H Davies
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Lydia Sit
- Covenant House of Pennsylvania, Philadelphia, Pennsylvania
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49
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Aslam S, Patsalides MA, Stoma S, Alfuhied A, Nelson CP, Squire IB, Lawson CA, Khunti K, McCann GP, Singh A. Aortic valve intervention rates in patients of different ethnicity with severe aortic stenosis in Leicestershire, UK. Open Heart 2023; 10:openhrt-2023-002266. [PMID: 37156572 PMCID: PMC10173973 DOI: 10.1136/openhrt-2023-002266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To explore the ethnic differences in patients undergoing aortic valve (AV) intervention for severe aortic stenosis (AS) in Leicestershire, UK. METHODS Retrospective cohort study of all surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) at a single tertiary centre between April 2017 and March 2022, using local registry data. RESULTS Of the 1231 SAVR and 815 TAVI performed, 6.5% and 3.7% were in ethnic minority patients, respectively. Based on the 2011 Census data for those with a Leicestershire postcode, crude cumulative rate of SAVR (n=489) was 0.64 per 1000 population overall and 0.69, 0.46 and 0.36 in White, Asian and Black populations, respectively; and 0.50 per 1000 population overall for TAVI (n=383), with 0.59, 0.16 and 0.06 for White, Asian and Black populations, respectively. Asians undergoing SAVR and TAVI were 5 and 3 years younger, respectively, than white patients with more comorbidities and a worse functional status.The age-adjusted cumulative rates for SAVR were 0.62 vs 0.72 per 1000 population for White and Asian patients and 0.51 vs 0.39 for TAVI. Asians were less likely to undergo SAVR and TAVI than White patients, with a risk ratio (RR) of 0.66 (0.50-0.87) and 0.27 (0.18-0.43), respectively, but the age-adjusted RR was not statistically significant. CONCLUSION The crude rates of AV interventions are lower in Asian patients compared with the White population in Leicestershire, although age-adjusted rates were not statistically different. Further research to determine the sociodemographic differences in prevalence, incidence, mechanisms and treatment of AS across the UK is required.
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Affiliation(s)
- Saadia Aslam
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Michalis A Patsalides
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Svetlana Stoma
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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50
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Davies H, Vleugels MJ, Kwan JY, Aerden A, Wyld L, Fawcett LE, Anthony R, Khan A, Wallace T, Van Den Beuken-Van Everdingen M, Schurink GW, Mees BME, Scott DJA. End of Life Care and Advance Care Planning for Outpatients with Inoperable Aortic Aneurysms. J Vasc Surg 2023:S0741-5214(23)01041-8. [PMID: 37076107 DOI: 10.1016/j.jvs.2023.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE A significant proportion of patients with abdominal and thoracic aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, until this study, there exist no studies on the end of life care conservatively managed patients receive. DESIGN This is a retrospective multicentre cohort study of 220 conservatively managed AA patients referred to Leeds Vascular Institute (UK) and Maastricht University Medical Centre (Netherlands) for intervention between 2017 and 2021. METHODS Demographic details, mortality, cause of death, advance care planning and palliative care outcomes were analysed to examine predictors of palliative care referral and efficacy of palliative care consultation. RESULTS A total of 1506 AA patients were seen over this time period, giving a non-intervention rate of 15%. There was a 3-year mortality rate of 55%, a median survival of 364 days and rupture was the reported cause of death in 18% of the decedents. Median follow up was 34 months. Only 8% of all patients and 16% of decedents received palliative care consultation, which took place a median of 3.5 days before death. Patients over 81 years of age were more likely to have advance care planning. Only 5% and 23% of conservatively managed patients had documentation of preferred place of death and care priorities respectively. Patients with palliative care consultation were more likely to have these in place. CONCLUSION Only a small proportion of conservatively treated patients had advance care planning and this was far below international guidelines on end of life care for adults, which recommend it for each of these patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention receive end of life care and advance care planning.
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Affiliation(s)
- Henry Davies
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
| | - Marie-José Vleugels
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jing Yi Kwan
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Alexander Aerden
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lucy Wyld
- Palliative Care, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Lee-Ellen Fawcett
- Proactive Care of Older People Going to Have Surgery Service, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Rebecca Anthony
- Proactive Care of Older People Going to Have Surgery Service, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Assad Khan
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Tom Wallace
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | | | - Geert Willem Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - D Julian A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
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