9967University of Alabama School of Medicine, Department of Medicine, Birmingham, Alabama, USA.
12275Washington University School of Medicine, Department of Medicine, St. Louis Missouri, USA.
Lupus. 2021 Oct;30(12):1998-2002. doi: 10.1177/09612033211045284. Epub 2021 Sep 16.
Patients with skin of color (P-SOC) are disproportionately burdened by lupus and often have worse disease outcomes than white patients. This is partly because educational materials underrepresent P-SOC, thereby promoting unconscious bias and clinical deficiencies among practitioners. We sought to measure providers' confidence in diagnosing the cutaneous manifestations of lupus (i.e., lupus-related rashes) in P-SOC and to assess which factors influenced their confidence. We created and distributed a survey that gathered information about participants' personal characteristics, clinical specialty, training, and current practice as well as measuring their confidence assessing lupus-related rashes in various skin tones. Practitioners from the fields of rheumatology, dermatology, and internal medicine in the greater St. Louis area (Missouri, USA) participated in the survey. We compared practitioners' mean confidence levels assessing lupus-related rashes in patients with fair skin and P-SOC with a linear mixed effects model and used univariate and multivariate linear regression models to determine if the aforementioned factors correlated with confidence. Participants' mean confidence in diagnosing lupus-related rashes in P-SOC was significantly lower than assessing such findings in patients with fair skin ( = .009). Several factors correlated with confidence level at a univariate level; however, the multivariate model revealed experience as the only factor significantly associated with confidence ( = .001). Providers report significantly less confidence assessing lupus-related rashes in P-SOC than in patients with fair skin. Our analysis demonstrates that experience positively correlates with confidence and suggests that interventions which enhance practitioners' exposure to and experience with these rashes in P-SOC can improve clinical confidence as well as patient outcomes.
皮肤色素沉着的患者（P-SOC）承受着不成比例的狼疮负担，并且往往比白人患者的疾病结局更差。这在一定程度上是因为教育材料对 P-SOC 的代表性不足，从而在从业者中促进了无意识的偏见和临床缺陷。我们试图衡量提供者在诊断 P-SOC 中狼疮的皮肤表现（即狼疮相关皮疹）方面的信心，并评估哪些因素影响了他们的信心。我们创建并分发了一份调查，收集了参与者的个人特征、临床专业、培训和当前实践信息，以及衡量他们在各种肤色下评估狼疮相关皮疹的信心。来自密苏里州（美国）圣路易斯地区的风湿病学、皮肤科和内科的从业者参与了这项调查。我们使用线性混合效应模型比较了从业者评估白皙皮肤和 P-SOC 患者中狼疮相关皮疹的平均信心水平，并使用单变量和多变量线性回归模型来确定上述因素是否与信心相关。参与者诊断 P-SOC 中狼疮相关皮疹的平均信心明显低于评估白皙皮肤患者的平均信心（ =.009）。一些因素在单变量水平上与信心水平相关；然而，多元模型显示经验是唯一与信心显著相关的因素（ =.001）。提供者报告在评估 P-SOC 中狼疮相关皮疹时的信心明显低于评估白皙皮肤患者时的信心。我们的分析表明，经验与信心呈正相关，并表明可以通过增加从业者对 P-SOC 中这些皮疹的暴露和经验的干预措施来提高临床信心和患者结局。
