Healthcare providers’ psychological investment in clinical recommendations: Investigating the role of implicit racial attitudes

IF 4.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Social Science & Medicine Pub Date : 2024-10-19 DOI:10.1016/j.socscimed.2024.117435
Conor M.C. Duffy , Emerson Do Bú , Cícero Roberto Pereira , Filipa Madeira , Nao Hagiwara
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Abstract

Racial disparities in clinical recommendations can result in racial disparities in health. While healthcare providers' implicit racial attitudes (affective component of bias) are theorized to be one major factor contributing to racial disparities in clinical recommendations, empirical evidence to support the link is lacking. This study aimed to bridge this gap by moving beyond the standard approach of operationalizing the quality of clinical recommendations as a guideline-consistent vs. -inconsistent dichotomy. The present secondary study examined the role of provider implicit racial attitudes in the quality of clinical recommendations, operationalized as behaviors reflecting providers’ psychological investment in patient care (i.e., number of words used to describe clinical recommendations, and number of treatment options recommended). Two-hundred-and-ten White medical trainees reviewed a clinical vignette of either a White or Black male patient and provided clinical recommendations. Their implicit racial attitudes were evaluated using the Implicit Association Test. Participants with more biased implicit racial attitudes (i.e., stronger implicit preference for White vs. Black individuals) used fewer words to describe their clinical recommendations and provided fewer clinical recommendations for the Black (vs. White) patient, while there were no significant differences between Black and White patients among participants with less biased implicit racial attitudes. These results illustrate the insidious impact of implicit racial attitudes in healthcare provision and underscore the need for researchers to consider the complex, nuanced ways in which provider implicit racial attitudes might manifest in clinical decision-making.
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医疗服务提供者对临床建议的心理投资:调查内隐种族态度的作用。
临床建议中的种族差异会导致健康方面的种族差异。虽然医疗服务提供者的内隐种族态度(偏见的情感成分)被认为是造成临床建议中种族差异的一个主要因素,但缺乏支持这种联系的实证证据。本研究旨在超越将临床建议的质量操作化为符合指南与不符合指南二分法的标准方法,从而弥合这一差距。本二次研究考察了医疗服务提供者的内隐种族态度在临床建议质量中的作用,并将其操作化为反映医疗服务提供者对患者护理的心理投入的行为(即用于描述临床建议的词汇数量和建议的治疗方案数量)。两百一十名白人医学实习生回顾了一名白人或黑人男性患者的临床小故事,并提供了临床建议。他们的内隐种族态度通过内隐关联测试进行评估。内隐种族态度偏向性较强的学员(即对白人与黑人的内隐偏好较强)在描述临床建议时使用的词汇较少,为黑人(与白人)患者提供的临床建议也较少,而内隐种族态度偏向性较小的学员在黑人与白人患者之间没有显著差异。这些结果说明了隐性种族态度在医疗保健服务中的潜移默化的影响,并强调研究人员有必要考虑医疗服务提供者的隐性种族态度在临床决策中可能表现出的复杂、微妙的方式。
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来源期刊
Social Science & Medicine
Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
9.10
自引率
5.60%
发文量
762
审稿时长
38 days
期刊介绍: Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.
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