Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA.
Department of Nursing, University of Colorado Anschutz Medical Center Campus, Aurora, CO, USA.
J Racial Ethn Health Disparities. 2018 Dec;5(6):1215-1229. doi: 10.1007/s40615-018-0468-z. Epub 2018 Mar 5.
Clinical decision-making may have a role in racial and ethnic disparities in healthcare but has not been evaluated systematically. The purpose of this study was to synthesize qualitative studies that explore various aspects of how a patient's African-American race or Hispanic ethnicity may factor into physician clinical decision-making. Using Ovid MEDLINE, Embase, and Cochrane Library, we identified 13 manuscripts that met inclusion criteria of usage of qualitative methods; addressed US physician clinical decision-making factors when caring for African-American, Hispanic, or Caucasian patients; and published between 2000 and 2017. We derived six fundamental themes that detail the role of patient race and ethnicity on physician decision-making, including importance of race, patient-level issues, system-level issues, bias and racism, patient values, and communication. In conclusion, a non-hierarchical system of intertwining themes influenced clinical decision-making among racial and ethnic minority patients. Future study should systematically intervene upon each theme in order to promote equitable clinical decision-making among diverse racial/ethnic patients.
临床决策可能在医疗保健中的种族和民族差异中发挥作用，但尚未得到系统评估。本研究的目的是综合探讨患者的非裔美国人种族或西班牙裔种族如何影响医生临床决策的各个方面的定性研究。我们使用 Ovid MEDLINE、Embase 和 Cochrane Library 检索了符合以下纳入标准的 13 篇文献：使用定性方法；当为非裔美国人、西班牙裔或白种人患者提供医疗服务时，涉及美国医生临床决策因素；并在 2000 年至 2017 年期间发表。我们得出了六个基本主题，详细说明了患者种族和民族对医生决策的影响，包括种族的重要性、患者层面的问题、系统层面的问题、偏见和种族主义、患者价值观以及沟通。总之，一个非层次化的主题交织系统影响了少数族裔患者的临床决策。未来的研究应该系统地干预每个主题，以促进不同种族/族裔患者之间公平的临床决策。
