Genetic counselors’ implicit racial attitudes and their relationship to communication.

Abstract

Objective Implicit racial attitudes are thought to shape interpersonal interactions and may contribute to health care disparities. This study explored the relationship between genetic counselors’ implicit racial attitudes and their communication during simulated genetic counseling sessions. Methods A nationally representative sample of genetic counselors completed a web-based survey that included the Race Implicit Association Test (IAT). A subset of these counselors (n=67) had participated in an earlier study in which they were video recorded counseling Black, Hispanic and non-Hispanic White simulated clients (SC) about their prenatal or cancer risks. The counselors’ IAT scores were related to their session communication through robust regression modeling. Results Genetic counselors showed a moderate to strong pro-White bias on the Race IAT (M=0.41, SD=0.35). Counselors with stronger pro-White bias were rated as displaying lower levels of positive affect (p<.05) and tended to use less emotionally responsive communication (p<.10) when counseling minority SCs. When counseling White SCs, pro-White bias was associated with lower levels of verbal dominance during sessions (p<.10). Stronger pro-White bias was also associated with more positive ratings of counselors’ nonverbal effectiveness by White SCs. Conclusions Implicit racial bias is associated with negative markers of communication in minority client sessions and may contribute to racial disparities in processes of care related to genetic services.

Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review

“…Consistent with other populations, health care providers demonstrate implicit biases indicative of more negative attitudes toward African Americans than Whites (Blair et al, 2013a; Cooper et al, 2012; Green et al, 2007; Haider et al, 2011, 2015a, 2015b; Hausmann et al, 2015; Oliver, Wells, Joy-Gaba, Hawkins, & Nosek, 2014; Sabin, Nosek, Greenwald, & Rivara, 2009; Schaa, Roter, Biesecker, Cooper, & Erby, 2015; Stepanikova, 2012; for null effects, see Penner et al, 2010; Sabin, Rivara, & Greenwald, 2008), more negative attitudes toward Latinos than Whites (Blair et al, 2013a, 2013b; Stepanikova, 2012), and somewhat more negative attitudes toward Native Americans than Whites (Sabin, Moore, Noonan, Lallemand, & Buchwald, 2015). Health care providers also exhibit negative implicit biases against overweight/obese individuals (Phelan et al, 2014; Sabin, Marini, & Nosek, 2012; Teachman & Brownell, 2001; Waller, Lampman, & Lupfer-Johnson, 2012), gay and lesbian people (Burke et al, 2015; Sabin, Riskind, Nosek, 2015), lower social class (Haider et al, 2011, 2015a, 2015b), injecting drug users (von Hippel, Brener, & von Hippel, 2008), and wheelchair users with spinal cord injuries (Galli, Lenggenhager, Scivoletto, Molinari, & Pazzagila, 2015).…”

Patient Perceptions of Telephone vs. In‐Person BRCA1/BRCA2 Genetic Counseling

“…It is also conceivable that the genetic counselors had more difficulty interpreting non-verbal cues from minority clients, as has been reported in other settings (Levine & Ambady, 2013). Conversely, delivery by telephone may reduce differences in underlying implicit biases by genetic counselors (Schaa, Roter, Biesecker, Cooper, & Erby, 2015), the occurrence of which has been reported in other medical settings (Blair et al, 2013; Cooper et al, 2012). Of note, however, non-Hispanic white participants reported overall higher satisfaction than minority participants.…”

Increasing diversity in the genetic counseling profession: Development of recruitment tools for African American undergraduate students

“…Genetic counselors are charged with delivering effective communication regardless of patients’ beliefs or backgrounds, and creating a diverse workforce could increase training opportunities for growth in cultural competency that would benefit patient care. A 2015 study recruited genetic counselors to take the Race Implicit Association Test, following which a small group of those counselors were video‐recorded in simulated prenatal and cancer consultations with minority patients (Schaa, Roter, Biesecker, Cooper, & Erby, 2015). The study found that the majority of counselors showed moderate‐to‐strong ‘pro‐White’ implicit bias.…”

“…The study found that the majority of counselors showed moderate-to-strong 'pro-White' implicit bias. The subset of individuals with 'stronger pro-White bias' were rated as displaying lower positive affect and using less emotionally responsive communication when counseling minorities (Schaa et al, 2015). In order to more effectively care for an increasingly diverse patient population, bor-intensive programs that involve funding from the initiating school, along with educational opportunities and faculty or professional mentorship (Brown & Marshall, 2008;Murray et al, 2016).…”