Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2020 Mar;109(3):938-944. doi: 10.1016/j.athoracsur.2019.06.066. Epub 2019 Aug 10.
Physician gender bias in surgical treatment recommendations is recognized but not well understood. This study hypothesized that gender differences may exist in interpretation of patients' physical behaviors and that these differences may be associated with decision making by providers and surrogate decision makers.
A pool of Amazon Mechanical Turk workers was solicited to participate in an online assessment. Workers viewed 3 short videos of standardized patients (SPs) trained to exhibit physical characteristics of vigorous, frail, and neither vigorous nor frail (average) behavior and then answered survey questions related to video characteristics and whether they would support the SP's decision to undergo an indicated major lung resection.
There were 724 participating workers; their mean age was 42.6 ± 11.8 years, and 386 were women. Men judged the average SP to be younger (P = .025), and women were more likely to recognize weight loss in the frail SP (P = .009). Overall, men and women were equally supportive of lung resection when indicated. The likelihood of supporting a decision to proceed with resection was inversely related to SP distress (P < .001) and was directly related to increasing gait speed (P < .001), energy (P < .001), and strength (P < .001). Male participants were less likely to support resection related to higher energy (P = .02) and strength levels (P = .016).
Gender differences exist in how video portrayal of patient frailty is perceived and affects surgical recommendations. Understanding such differences may aid in educational efforts directed at reducing gender-based biases in treatment recommendations by physicians and surrogate decision makers.
医师在手术治疗建议中的性别偏见是公认的，但并未得到很好的理解。本研究假设在解释患者的身体行为方面可能存在性别差异，并且这些差异可能与提供者和替代决策人做出决策有关。
邀请亚马逊土耳其机器人（Amazon Mechanical Turk）的工作人员参与在线评估。工作人员观看了 3 个标准化患者（SP）的短视频，这些患者接受过培训以表现出活跃、虚弱和既不活跃也不虚弱（平均）的身体特征，然后回答了与视频特征以及他们是否支持 SP 决定进行有指征的主要肺切除术相关的调查问题。
共有 724 名参与工作人员；他们的平均年龄为 42.6±11.8 岁，其中 386 名女性。男性判断平均 SP 的年龄较小（P=0.025），而女性更容易识别虚弱 SP 的体重减轻（P=0.009）。总体而言，当有指征时，男性和女性对肺切除术的支持程度相同。支持进行切除手术的可能性与 SP 的痛苦程度呈负相关（P<0.001），并与步态速度（P<0.001）、能量（P<0.001）和力量（P<0.001）的增加直接相关。男性参与者不太支持与更高能量（P=0.02）和力量水平（P=0.016）相关的切除手术。
在如何感知患者虚弱的视频表现以及如何影响手术建议方面存在性别差异。了解这些差异可能有助于减少医生和替代决策人在治疗建议中基于性别的偏见的教育工作。
