Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA.
J Genet Couns. 2020 Jun;29(3):332-341. doi: 10.1002/jgc4.1243. Epub 2020 Mar 6.
Previous studies have linked clinicians' implicit racial bias with less patient-centered communication between healthcare providers and patients in a variety of healthcare contexts. The current study extends this research by exploring the influence of implicit racial bias in genetic counselors' (GCs') facilitation of simulated clients' cognitive and emotional processing during genetic counseling sessions. We conducted a secondary analysis of a nationally representative sample of genetic counseling sessions of White and ethnic and/or racial minority (Black and Latinx) simulated clients with a subset of 60 GCs who had completed a Race Implicit Association Test (IAT). Linguistic Inquiry Word Count (LIWC) was applied to session transcripts to identify word use by the simulated client consistent with emotional and cognitive processing. The Roter Interaction Analysis System (RIAS) was used to link GC statements consistent with facilitation of emotional and cognitive processing, as used in previous studies. Multiple linear regression analyses were performed to relate LIWC and RIAS variables to GC IAT scores, client race/ethnicity, and statistical interaction between GC IAT scores and client race/ethnicity. GCs used more cognitive facilitation strategies with ethnic and/or racial minority than with White clients (p = .04). There were no statistically significant associations between GCs' pro-White implicit bias and GCs' facilitation of cognitive and emotional processing or clients' use of positive, negative, or cognitive process words. While implicit bias may affect some communication processes, our analysis did not show a relationship between GC IAT score and how GCs help clients process emotional or cognitive information conveyed during a session. It is also possible that the LIWC measure of cognitive and emotional processing is not a sensitive enough measure to capture an implicit bias effect if indeed one is present.
先前的研究表明，在各种医疗保健环境中，临床医生的隐性种族偏见与医疗保健提供者和患者之间以患者为中心的沟通较少有关。本研究通过探索遗传咨询师（GC）在遗传咨询过程中促进模拟客户认知和情绪处理的隐性种族偏见的影响，扩展了这一研究。我们对具有种族/民族（黑人和拉丁裔）模拟客户的全国代表性遗传咨询会议样本进行了二次分析，其中包括 60 名已经完成种族内隐联想测验（IAT）的 GC。对会议记录进行了语言学探究词频（LIWC）分析，以确定模拟客户在情绪和认知处理方面一致的词汇使用。使用罗特互动分析系统（RIAS）将与促进情绪和认知处理一致的 GC 陈述联系起来，这在先前的研究中已经使用过。进行了多元线性回归分析，以将 LIWC 和 RIAS 变量与 GC 的 IAT 分数、客户的种族/民族以及 GC 的 IAT 分数和客户的种族/民族之间的统计相互作用联系起来。GC 与少数民族/种族的模拟客户比与白人客户使用更多的认知促进策略（p =.04）。GC 亲白的隐性偏见与 GC 促进认知和情绪处理或客户使用积极、消极或认知处理词之间没有统计学上的显著关联。虽然隐性偏见可能会影响某些沟通过程，但我们的分析并未显示 GC 的 IAT 分数与 GC 如何帮助客户在会议期间处理传达的情绪或认知信息之间存在关系。也有可能，如果确实存在隐性偏见效应，LIWC 对认知和情绪处理的衡量标准不够敏感，无法捕捉到这种效应。
