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

Zestcott, Colin A.; Blair, Irene V.; Stone, Jeff

doi:10.1177/1368430216642029

Cited by 295 publications

(252 citation statements)

References 111 publications

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“…However, the absence of declared racism does not mean that implicit bias is not widespread throughout the health system. Racism does not have to be overt or conscious to have negative implications for patient outcomes (Paradies, Truong, & Priest, 2014;Reilly, Ogdie, Von Feldt, & Myers, 2013;Zestcott, Blair, & Stone, 2016).…”

Section: Non-mäori Perspectives and The Role Of Implicit Biasmentioning

confidence: 99%

What you can't see can hurt you: How do stereotyping, implicit bias and stereotype threat affect Māori health?

Houkamau¹

2016

MAI Journal

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A number of studies demonstrate Mäori receive a poorer standard of healthcare than Päkehä and other non-Mäori in New Zealand. Implicit bias on the part of healthcare providers has been cited as a key contributor to health inequities internationally; however, the concept has not yet been explored in relation to Mäori health. This paper addresses that research gap and describes a theoretical basis for further research on the role of bias for Mäori health outcomes. Drawing from empirical research and theories formulated in social psychology, the paper considers the relevance of implicit bias, stereotyping and stereotype threat for Mäori health outcomes. These have not been integrated and applied to the problem of Mäori health inequities per se; however, it is proposed that they provide a useful conceptual lens for understanding how interpersonal dynamics between Mäori and Päkehä help perpetuate health disparities. Suggestions for further research are also made.

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Section: Non-mäori Perspectives and The Role Of Implicit Biasmentioning

confidence: 99%

What you can't see can hurt you: How do stereotyping, implicit bias and stereotype threat affect Māori health?

Houkamau¹

2016

MAI Journal

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“…Our study provides evidence of the presence of physician gender bias, raising the question of whether implicit bias is modifiable 34. The first step in minimizing any potential negative effects of implicit bias is increasing awareness.…”

Section: Discussionmentioning

confidence: 67%

“…The first step in minimizing any potential negative effects of implicit bias is increasing awareness. Awareness of unwanted implicit stereotypes and being motivated to counteract them—or creating structures that minimize their effects—may help ensure that implicit bias does not overtly influence behavior 34, 60. Implicit bias is modifiable in experimental settings using counterstereotyping exercises; however, these methods have not been applied in a clinical setting 61.…”

Section: Discussionmentioning

confidence: 99%

“…The IAT measures bias through speed of response (reaction time), operating on the principle that it is easier to pair concepts that are more strongly associated in one's minds than to pair concepts less strongly associated, regardless of one's conscious beliefs or values 31. The IAT has been used to measure race/ethnicity bias and has predicts behavior including physicians' treatment recommendations for hypothetical patients 28, 34. Although the IAT has been used to measure implicit gender bias in career and educational roles,35, 36 no study has examined the association between implicit gender bias and decision‐making in health care 12…”

Section: Introductionmentioning

confidence: 99%

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Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists

Daugherty

Blair

Havranek

et al. 2017

JAHA

Self Cite

106

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BackgroundPhysicians' gender bias may contribute to gender disparities in cardiovascular testing. We used the Implicit Association Test to examine the association of implicit gender biases with decisions to use cardiovascular tests.Methods and ResultsIn 2014, cardiologists completed Implicit Association Tests and a clinical vignette with patient gender randomly assigned. The Implicit Association Tests measured implicit gender bias for the characteristics of strength and risk taking. The vignette represented an intermediate likelihood of coronary artery disease regardless of patient gender: chest pain (part 1) followed by an abnormal exercise treadmill test (part 2). Cardiologists rated the likelihood of coronary artery disease and the usefulness of stress testing and angiography for the assigned patient. Of the 503 respondents (9.3% of eligible; 87% male, median age of 45 years, 58% in private practice), the majority associated strength or risk taking implicitly with male more than female patients. The estimated likelihood of coronary artery disease for both parts of the vignette was similar by patient gender. The utility of secondary stress testing after an abnormal exercise treadmill test was rated as “high” more often for female than male patients (32.8% versus 24.3%, P=0.04); this difference did not vary with implicit bias. Angiography was more consistently rated as having “high” utility for male versus female patients (part 1: 19.7% versus 9.8%; part 2: 73.7% versus 64.3%; P<0.05 for both); this difference was larger for cardiologists with higher implicit gender bias on risk taking (P=0.01).ConclusionsCardiologists have varying degrees of implicit gender bias. This bias explained some, but not all, of the gender variability in simulated clinical decision‐making for suspected coronary artery disease.

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“…To date, none of these has produced any blockbuster success. According to Zestcott et al,138 more research is needed to determine which of these interventions are effective, to understand how provider bias affects care, and how to motivate providers to control implicit bias.One window into understanding these dynamics may have opened recently and surreptitiously, while shining a plausible and promising path to success. …”

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confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

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

Cited by 295 publications

References 111 publications

What you can't see can hurt you: How do stereotyping, implicit bias and stereotype threat affect Māori health?

What you can't see can hurt you: How do stereotyping, implicit bias and stereotype threat affect Māori health?

Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

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