Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients

Department of Psychology and Neuro-science, University of Colorado Boulder, Boulder, Colorado.
The Annals of Family Medicine (Impact Factor: 4.57). 01/2013; 11(1):43-52. DOI: 10.1370/afm.1442
Source: PubMed

ABSTRACT PURPOSE We investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships. METHODS We administered a telephone survey to 2,908 patients, stratified by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales. RESULTS Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians' implicit bias (P = .98). CONCLUSIONS This is among the first studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our findings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias.

Download full-text


Available from: Michael Bronsert, Sep 02, 2014
1 Follower
  • The Annals of Family Medicine 01/2013; 11(1):2-4. DOI:10.1370/afm.1447 · 4.57 Impact Factor
  • Annals of Behavioral Medicine 03/2013; 45(3). DOI:10.1007/s12160-013-9488-4 · 4.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: African Americans are consistently underrepresented in cancer clinical trials. Minority under-enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients. To investigate differences in oncologist-patient communication during offers to participate in clinical trials in oncology visits with African American and White patients. From an archive of video-recorded oncology visits, we selected all visits with African American patients that included a trial offer (n = 11) and a matched sample of visits with demographically/medically comparable White patients (n = 11). Using mixed qualitative-quantitative methods, we assessed differences by patient race in (i) word count of entire visits and (ii) frequency of mentions and word count of discussions of clinical trials and key elements of consent. Visits with African American patients, compared to visits with White patients, were shorter overall and included fewer mentions of and less discussion of clinical trials. Also, visits with African Americans included less discussion of the purpose and risks of trials offered, but more discussion of voluntary participation. African American patients may make decisions about clinical trial participation based on less discussion with oncologists than do White patients. Possible explanations include a less active communication style of African Americans in medical visits, oncologists' concerns about patient mistrust, and/or oncologist racial bias. Findings suggest oncologists should pay more conscious attention to developing the topic of clinical trials with African American patients, particularly purpose and risks.
    Health expectations: an international journal of public participation in health care and health policy 08/2013; DOI:10.1111/hex.12108 · 2.85 Impact Factor