Flynn Tommy J, Jennings Bonnie Mowinski, Wright David W, Vigfusson Ymir, Evans Dian D, Hertzberg Vicki, Burns Emily J, Yeager Katherine A
Department of Nursing, Benioff Children's Hospital, University of California San Francisco, California, United States of America.
Nell Hodgson Woodruff School of Nursing, Emory University, Georgia, United States of America.
PLoS One. 2025 Jun 25;20(6):e0325315. doi: 10.1371/journal.pone.0325315. eCollection 2025.
Evidence shows that patients identified as Black experience worse emergency department (ED) care compared to patients identified as White. Clinical interactions (CI) are thought to affect racial disparities, but no systematic reviews to date have synthesized the evidence on the effects of patient race on CI processes and experiences.
We synthesized evidence from published studies comparing observed and/or patient-reported CI processes and experiences between patients identified as Black and White in US EDs.
This was a mixed-methods systematic review following the Joanna Briggs Institute guidelines and registered a priori with PROSPERO (CRD42021281653). We used a broad search strategy to query six databases. Peer-reviewed original research reports comparing processes or experiences of CIs between Black and White patients in US EDs from 2004 to 2024 were eligible for inclusion.
Nine studies met inclusion criteria. Of these, three focused on observational CI processes and six focused on patient-reported CI experiences. Evidence of differences in CI processes and patient-reported experiences between Black and White patients was inconclusive. We identified four themes across measures used in studies of patient reported CI experiences, however, including responsive nonverbal behavior, effective verbal communication, person centeredness, and patient satisfaction.
Research on the effects of patient race on ED CIs is lacking, especially research with observed real-world CI processes. Psychometrically robust instruments and conceptual clarity in the study of racial disparities in CI experiences are needed. We provide groundwork for future research development on racial disparities in ED CIs.
有证据表明，与被认定为白人的患者相比，被认定为黑人的患者在急诊科接受的治疗更差。临床互动（CI）被认为会影响种族差异，但迄今为止，尚无系统评价综合关于患者种族对CI过程和体验影响的证据。
我们综合了已发表研究中的证据，比较美国急诊科中被认定为黑人和白人的患者之间观察到的和/或患者报告的CI过程及体验。
这是一项遵循乔安娜·布里格斯研究所指南的混合方法系统评价，并事先在国际系统评价注册平台（PROSPERO，注册号：CRD42021281653）进行了注册。我们采用广泛的检索策略查询了六个数据库。2004年至2024年期间比较美国急诊科黑人和白人患者CI过程或体验的同行评审原始研究报告符合纳入标准。
九项研究符合纳入标准。其中三项关注观察性CI过程，六项关注患者报告的CI体验。黑人和白人患者在CI过程和患者报告体验方面存在差异的证据尚无定论。然而，我们在患者报告的CI体验研究中使用的各项测量指标中确定了四个主题，包括反应性非语言行为、有效的言语沟通、以患者为中心和患者满意度。
关于患者种族对急诊科CI影响的研究不足，尤其是对观察到的实际CI过程的研究。在CI体验种族差异研究中需要心理测量学上稳健的工具和概念清晰度。我们为急诊科CI种族差异的未来研究发展提供了基础。
