FitzGerald Chloë, Hurst Samia
Institute for Ethics, History, and the Humanities, Faculty of Medicine University of Geneva, Genève, Switzerland.
BMC Med Ethics. 2017 Mar 1;18(1):19. doi: 10.1186/s12910-017-0179-8.
Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients.
PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies.
Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals' attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care.
The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics.
Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
内隐偏见涉及意识之外的关联，这种关联会导致基于种族或性别等无关特征对某人产生负面评价。本综述考察了医疗保健专业人员对患者表现出内隐偏见的证据。
检索了PubMed、PsychINFO、PsychARTICLE和CINAHL中2003年3月1日至2013年3月31日发表的同行评审文章。两名评审员根据精确的内容和质量标准评估所确定论文的合格性。对合格论文的参考文献进行检查以识别更多合格研究。
确定42篇文章合格。17篇使用内隐测量方法（15篇使用内隐联想测验，2篇使用阈下启动）来测试医疗保健专业人员的偏见。25篇文章采用组间设计，使用 vignettes 来考察患者特征对医疗保健专业人员的态度、诊断和治疗决策的影响。虽然第二种方法没有分离出内隐态度，但专门研究内隐认知的心理学家认为它是检测内隐偏见可能存在的一种方式，因此也被纳入。27项研究考察了种族/民族偏见；还调查了其他10种偏见，包括性别、年龄和体重。35篇文章发现医疗保健专业人员存在内隐偏见的证据；所有调查相关性的研究都发现内隐偏见程度与较低的医疗质量之间存在显著正相关。
证据表明，医疗保健专业人员表现出与更广泛人群相同程度的内隐偏见。多种患者特征之间以及医疗保健专业人员与患者特征之间的相互作用揭示了内隐偏见现象及其对医患互动影响的复杂性。我们综述中最有说服力的研究是那些将内隐联想测验与一种测量现实世界中治疗质量的方法相结合的研究。相关证据表明，偏见在某些情况下可能会影响诊断、治疗决策和医疗水平，需要进一步研究。我们的综述还表明，在公正性规范与医疗保健专业人员对某些测试特征的接受程度之间有时可能存在差距。
我们的研究结果凸显了医疗行业解决内隐偏见在医疗保健差异中所起作用的必要性。需要在实际护理环境中进行更多研究，并在用于测试医疗保健中内隐偏见的方法上实现更大的同质性。
