Mulchan Siddika S, Theriault Christopher B, DiVietro Susan, Litt Mark D, Sukhera Javeed, Tanabe Paula, Thomas Hannah R, Zempsky William T, Boruchov Donna, Hirsh Adam T
Connecticut Children's, University of Connecticut School of Medicine, Farmington, USA.
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, USA.
J Racial Ethn Health Disparities. 2024 Jul 17. doi: 10.1007/s40615-024-02086-x.
BACKGROUND/OBJECTIVES: This study is to (1) assess implicit racial bias among pediatric providers and (2) use virtual patient (VP) vignettes to determine the impact of implicit racial bias on clinical decision-making in pediatric sickle cell disease (SCD) pain care.
DESIGN/METHODS: This cross-sectional study was conducted at a mid-sized, freestanding children's hospital in the northeast. Participants (N = 52) were pediatric SCD providers (87% cisgender female, 90% White, M age = 38.78). Providers completed a demographic questionnaire, the race Implicit Association Test (IAT) with adult and child faces, and a measure of SCD explicit bias (5-point Likert scale). Providers also made clinical decisions for four VP vignettes depicting Black and White youth in the emergency department (ED) with either SCD or cancer pain. Frequency tables were calculated.
On the race IAT, providers demonstrated a pro-White implicit bias for both adult (81%) and child (89%) faces. Responses to the explicit bias measure reflected low levels of agreement with negative stereotypes about SCD patients. No significant differences emerged in providers' pain treatment decisions for Black vs. White, or SCD vs. cancer VPs.
Findings indicate pediatric providers harbor implicit racial bias similar to the general population. Findings from VP vignettes did not demonstrate that pain treatment decision-making differed based on race or diagnosis. This may be due to standardized protocols and procedures in the pediatric emergency setting. Future research is needed to clarify the role of implicit bias in clinical decision-making and the potential efficacy of treatment protocols in preventing biases from interfering with pediatric SCD pain care.
背景/目的：本研究旨在（1）评估儿科医疗服务提供者中隐性种族偏见情况，以及（2）使用虚拟患者（VP）案例来确定隐性种族偏见对小儿镰状细胞病（SCD）疼痛护理临床决策的影响。
设计/方法：这项横断面研究在东北部一家中型独立儿童医院进行。参与者（N = 52）为儿科SCD医疗服务提供者（87%为顺性别女性，90%为白人，平均年龄 = 38.78岁）。医疗服务提供者完成了一份人口统计学调查问卷、针对成人和儿童面孔的种族内隐联想测验（IAT），以及一项SCD显性偏见测量（5点李克特量表）。医疗服务提供者还针对四个VP案例做出临床决策，这些案例描绘了急诊科中患有SCD或癌症疼痛的黑人和白人青少年。计算了频率表。
在种族IAT中，医疗服务提供者对成人（81%）和儿童（89%）面孔均表现出亲白人的隐性偏见。对显性偏见测量的回答反映出对SCD患者负面刻板印象的认同程度较低。在医疗服务提供者对黑人与白人、SCD与癌症VP的疼痛治疗决策中，未出现显著差异。
研究结果表明，儿科医疗服务提供者存在与普通人群相似的隐性种族偏见。VP案例的研究结果并未表明疼痛治疗决策因种族或诊断而异。这可能是由于儿科急诊环境中的标准化方案和程序。未来需要开展研究，以阐明隐性偏见在临床决策中的作用，以及治疗方案在防止偏见干扰小儿SCD疼痛护理方面的潜在效果。
