The Ohio State University College of Nursing, Columbus, Ohio, USA.
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Acad Emerg Med. 2023 Dec;30(12):1192-1200. doi: 10.1111/acem.14767. Epub 2023 Jul 13.
Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care.
This mixed-methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow-up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line-by-line coding for thematic descriptions.
The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). "No" or "rare" experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors-communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit.
Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.
基于种族和民族的急诊科（ED）护理差异已经得到证实。患者对紧急护理的看法可能会产生广泛的影响，包括健康状况不佳。我们的目标是衡量和探讨患者在 ED 护理过程中经历的微侵犯和歧视。
这项对来自两家城市学术 ED 的成年患者进行的混合方法研究整合了定量歧视测量和 ED 护理期间歧视经历的半结构化访谈。参与者完成了人口统计问卷和医疗环境中的歧视（DMS）量表，并被邀请参加后续访谈。使用常规内容分析对记录的访谈记录进行分析，逐行编码进行主题描述。
该队列包括 52 名参与者，其中 30 名完成了访谈。近一半的参与者是黑人（n=24，46.1%），一半是男性（n=26，50%）。48 名参与者中有 22 名（46%）报告在 ED 就诊期间没有或很少经历歧视，19 名（39%）报告有些/中度歧视，7 名（15%）报告严重歧视。发现了五个主要主题：（1）临床医生行为-沟通和同理心，（2）对医疗保健团队行为的情绪反应，（3）歧视的感知原因，（4）ED 中的环境压力，以及（5）患者不愿抱怨。我们发现了一个新的概念，即 DMS 得分较高/较高的人在讨论歧视事件时，经常反思以前的医疗保健经验，而不是当前的 ED 就诊经历。
患者将微侵犯归因于许多因素，而不仅仅是种族和性别，包括年龄、社会经济地位和 ED 中的环境压力。在最近的 ED 就诊期间通过调查回应表示中度至显著歧视的患者中，大多数人在访谈中描述了过去歧视的经历。以前的歧视经历可能会对患者对当前医疗保健的看法产生持久影响。系统和临床医生对患者融洽关系和满意度的投资对于防止对未来遭遇的负面预期和抵消已经存在的预期非常重要。
