Department of Psychology, Virginia Commonwealth University, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA; Institute of Social Sciences, University of Lisbon, Portugal.
Soc Sci Med. 2024 Dec;362:117435. doi: 10.1016/j.socscimed.2024.117435. Epub 2024 Oct 19.
Racial disparities in clinical recommendations can result in racial disparities in health. While healthcare providers' implicit racial attitudes (affective component of bias) are theorized to be one major factor contributing to racial disparities in clinical recommendations, empirical evidence to support the link is lacking. This study aimed to bridge this gap by moving beyond the standard approach of operationalizing the quality of clinical recommendations as a guideline-consistent vs. -inconsistent dichotomy. The present secondary study examined the role of provider implicit racial attitudes in the quality of clinical recommendations, operationalized as behaviors reflecting providers' psychological investment in patient care (i.e., number of words used to describe clinical recommendations, and number of treatment options recommended). Two-hundred-and-ten White medical trainees reviewed a clinical vignette of either a White or Black male patient and provided clinical recommendations. Their implicit racial attitudes were evaluated using the Implicit Association Test. Participants with more biased implicit racial attitudes (i.e., stronger implicit preference for White vs. Black individuals) used fewer words to describe their clinical recommendations and provided fewer clinical recommendations for the Black (vs. White) patient, while there were no significant differences between Black and White patients among participants with less biased implicit racial attitudes. These results illustrate the insidious impact of implicit racial attitudes in healthcare provision and underscore the need for researchers to consider the complex, nuanced ways in which provider implicit racial attitudes might manifest in clinical decision-making.
临床推荐中的种族差异可能导致健康方面的种族差异。虽然医疗保健提供者的隐性种族态度（偏见的情感成分）被认为是导致临床推荐中种族差异的一个主要因素，但缺乏支持这一联系的经验证据。本研究旨在通过超越将临床推荐质量操作化为符合与不符合指南的二分法的标准方法来弥合这一差距。本二次研究探讨了提供者隐性种族态度在临床推荐质量中的作用，其操作化为反映提供者对患者护理心理投入的行为（即，用于描述临床推荐的单词数量，以及推荐的治疗方案数量）。210 名白人医学实习生查看了一名白人或黑人男性患者的临床案例并提供了临床建议。他们的隐性种族态度使用内隐联想测验进行评估。具有更具偏见的隐性种族态度（即，对白人相对于黑人个体的隐性偏好更强）的参与者在描述其临床建议时使用的单词较少，并且为黑人（相对于白人）患者提供的临床建议较少，而在隐性种族态度偏见较小的参与者中，黑人和白人患者之间没有显著差异。这些结果说明了隐性种族态度在医疗保健提供中的潜在影响，并强调了研究人员需要考虑提供者隐性种族态度在临床决策中表现出来的复杂、微妙的方式。
