Hagiwara Nao, Mezuk Briana, Elston Lafata Jennifer, Vrana Scott R, Fetters Michael D
Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Open. 2018 Oct 18;8(10):e022623. doi: 10.1136/bmjopen-2018-022623.
Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions. The overall goal of this research is to identify physician communication behaviours that link physician implicit racial bias and Black patient immediate (patient-reported satisfaction and trust) and long-term outcomes (eg, medication adherence, self-management and healthcare utilisation) as well as clinical indicators of diabetes control (eg, blood pressure, HbA1c and history of diabetes complication).
Using an exploratory sequential mixed methods research design, we will collect data from approximately 30 family medicine physicians and 300 Black patients with type 2 diabetes mellitus. The data sources will include one physician survey, three patient surveys, medical interaction videos, video elicitation interviews and medical chart reviews. Physician implicit racial bias will be assessed with the physician survey, and patient outcomes will be assessed with the patient surveys and medical chart reviews. In video elicitation interviews, a subset of patients (approximately 20-40) will watch their own interactions while being monitored physiologically to identify evocative physician behaviours. Information from the interview will determine which physician communication behaviours will be coded from medical interactions videos. Coding will be done independently by two trained coders. A series of statistical analyses (zero-order correlations, partial correlations, regressions) will be conducted to identify physician behaviours that are associated significantly with both physician implicit racial bias and patient outcomes.
Ethics approval was obtained from the Virginia Commonwealth University IRB. Study results will be disseminated through publications in peer-reviewed journals and presentations at conferences. A novel from this project will be made publicly available.
患者与医生之间的种族差异与黑人患者的不满和不信任报告相关，而这反过来又与对治疗建议的依从性差和医疗保健利用不足有关。进一步的研究表明，当医生存在高度的隐性种族偏见时，患者的不满和不信任会被放大。这表明医生的隐性种族偏见在医疗互动中的沟通行为中表现出来。本研究的总体目标是确定医生的沟通行为，这些行为将医生的隐性种族偏见与黑人患者的即时（患者报告的满意度和信任）和长期结果（如药物依从性、自我管理和医疗保健利用）以及糖尿病控制的临床指标（如血压、糖化血红蛋白和糖尿病并发症史）联系起来。
采用探索性序列混合方法研究设计，我们将从大约30名家庭医学医生和300名患有2型糖尿病的黑人患者中收集数据。数据来源将包括一份医生调查问卷、三份患者调查问卷、医疗互动视频、视频诱导访谈和病历审查。医生的隐性种族偏见将通过医生调查问卷进行评估，患者的结果将通过患者调查问卷和病历审查进行评估。在视频诱导访谈中，一部分患者（约20 - 40名）将在生理监测的同时观看自己的互动，以识别引发情绪的医生行为。访谈信息将确定哪些医生沟通行为将从医疗互动视频中进行编码。编码将由两名经过培训的编码员独立完成。将进行一系列统计分析（零阶相关性、偏相关性、回归分析），以确定与医生隐性种族偏见和患者结果均显著相关的医生行为。
已获得弗吉尼亚联邦大学机构审查委员会的伦理批准。研究结果将通过在同行评审期刊上发表以及在会议上进行展示来传播。本项目的一项新成果将公开提供。
