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一项针对儿科镰状细胞病疼痛护理中解决医疗服务提供者隐性偏见的干预措施的初步评估:一项混合方法试点研究。

Initial evaluation of an intervention to address provider implicit bias in pediatric sickle cell disease pain care: A mixed methods pilot study.

作者信息

Mulchan Siddika S, Theriault Christopher B, DiVietro Susan, Litt Mark D, Wakefield Emily O, Sukhera Javeed, Tanabe Paula, Thomas Hannah R, Santos Melissa, Zempsky William T, Boruchov Donna, Hirsh Adam T

机构信息

Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut, USA.

Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA.

出版信息

Can J Pain. 2025 May 9;8(2):2486819. doi: 10.1080/24740527.2025.2486819. eCollection 2024.

Abstract

BACKGROUND

Health care provider (HCP) implicit bias can impact health outcomes for youth with sickle cell disease (SCD).

AIMS

: The aim of this study was to evaluate the feasibility, acceptability, and preliminary impact of an individuation and perspective-taking (IPT) intervention to decrease implicit bias and improve pain treatment clinical decision making in pediatric SCD HCPs.

METHODS

This mixed methods pilot randomly assigned HCPs ( = 36) to an intervention ( = 17) or control condition ( = 19). Implicit and explicit bias measures were administered pretreatment and 3 months postintervention. Differences were analyzed using repeated measures analyses of variance. HCP ratings of virtual patient vignettes depicting Black and White youth with SCD or cancer pain were used to assess differential clinical decision making based on race and diagnosis and analyzed using hierarchical linear mixed model analysis. Focus groups with intervention participants were analyzed using thematic analysis.

RESULTS

No significant differences in scores on bias measures across time, condition, or the Condition × Time interaction were found (all < 0.05). Significant differences in HCP ratings were found between types of HCPs ( < 0.001), but no effects were attributable to condition, time, virtual patient race, or diagnosis. Ten themes were extracted regarding the intervention's format, structure, and content.

CONCLUSIONS

This study is the first to evaluate an IPT intervention in pediatric SCD HCPs. HCPs deemed the intervention feasible, acceptable, and impactful and suggested areas for improvement. Future research should refine the intervention to incorporate greater patient involvement and skills practice to improve health outcomes for this underserved population.

摘要

背景

医疗服务提供者(HCP)的隐性偏见会影响镰状细胞病(SCD)青少年的健康结局。

目的

本研究的目的是评估个体化与换位思考(IPT)干预措施在减少儿科SCD医疗服务提供者隐性偏见和改善疼痛治疗临床决策方面的可行性、可接受性和初步影响。

方法

这项混合方法试点研究将医疗服务提供者(n = 36)随机分配至干预组(n = 17)或对照组(n = 19)。在干预前和干预后3个月进行隐性和显性偏见测量。使用重复测量方差分析来分析差异。医疗服务提供者对描述患有SCD或癌症疼痛的黑人和白人青少年的虚拟患者病例的评分,用于评估基于种族和诊断的差异临床决策,并使用分层线性混合模型分析进行分析。对干预参与者的焦点小组进行主题分析。

结果

在偏见测量得分上,未发现时间、组别或组别×时间交互作用的显著差异(所有p < 0.05)。在不同类型的医疗服务提供者之间发现了显著差异(p < 0.001),但没有效应可归因于组别、时间、虚拟患者种族或诊断。提取了关于干预形式、结构和内容的十个主题。

结论

本研究是首次评估针对儿科SCD医疗服务提供者的IPT干预措施。医疗服务提供者认为该干预措施可行、可接受且有影响,并提出了改进领域。未来的研究应完善干预措施,纳入更多患者参与和技能实践,以改善这一服务不足人群的健康结局。

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