Implicit Physician Biases in Periviability Counseling

Shapiro, Natasha; Wachtel, Elena V.; Bailey, Sean M.; Espiritu, Michael M

doi:10.1016/j.jpeds.2018.01.070

Cited by 35 publications

(17 citation statements)

References 25 publications

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“…These prejudices or implicit biases concerning some ethnic or cultural groups can thus lead to differential care, manifested by the disparities observed here. While the existence of implicit bias has been demonstrated repeatedly by physicians in different specialties (20)(21)(22)(23)(24)(25)(26), including in perinatal medicine (27), very little proof exists of its manifestations in terms of differential care (20,(28)(29)(30). Other work nonetheless converges with ours to support this hypothesis.…”

Section: Discussionsupporting

confidence: 51%

Does women’s place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France

Anselem

Saurel‐Cubizolles

Khoshnood

et al. 2020

Preprint

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Objectives To examine disparities in the opportunity to make an informed choice about Down syndrome screening by maternal place of birth, in France, where the French national authority for health (HAS) recommends that physicians offer it to all. Material and methods We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N = 24,644 women) to analyse the opportunity for an informed choice for prenatal screening, measured by a composite indicator. Results Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in Sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and level of perinatal care of the maternity, women born outside France had less often the opportunity to make an informed choice as compared with women born in France. This association remained essentially the same even after excluding women without adequate prenatal care. Conclusion Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.

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Section: Discussionsupporting

confidence: 51%

Does women’s place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France

Anselem

Saurel‐Cubizolles

Khoshnood

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 51%

Does women’s place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France.

Anselem

Saurel‐Cubizolles

Khoshnood

et al. 2020

Preprint

View full text Add to dashboard Cite

Background To examine disparities in the opportunity to make an informed choice about Down syndrome screening by maternal place of birth, in France, where the French national authority for health (HAS) recommends that physicians offer it to all. We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator. Results Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in Sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and level of perinatal care of the maternity, women born outside France had less often the opportunity to make an informed choice as compared with women born in France. This association remained essentially the same even after excluding women without adequate prenatal care. Conclusions Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.

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“…Implicit bias in periviable counselling by neonatologists has previously been demonstrated by Shapiro et al, who suggest that clinicians who show negative bias towards socioeconomic status were more likely than those who did not show bias to recommend palliative (comfort) care when presented with a patient of greater socioeconomic status [48]. The authors hypothesised that this could be because the clinicians identified more closely with these patients and that this reflected what they would choose for themselves.…”

Section: Discussionmentioning

confidence: 95%

Exploring implicit bias in the perceived consequences of prematurity amongst health care providers in North Queensland – a constructivist grounded theory study

Ireland

Ray

Larkins

et al. 2021

BMC Pregnancy Childbirth

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Background A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies. Methods/design Applying a constructivist grounded theory methodology, HCP were interviewed about their attitudes towards the provision of resuscitation and intensive care for extremely premature babies. These babies are at increased risk of death and neurodisability when compared to babies of older gestations. Participants included HCP of varying disciplines at a large tertiary centre, a regional centre and a remote centre. Staff with a wide range of experience were interviewed. Results Six categories of i) who decides, ii) culture and context of families, iii) the life ahead, iv) to treat a bit or not at all, v) following guidelines and vi) information sharing, emerged. Role specific implicit bias was found as a theoretical construct, which depended on the period for which care was provided relative to the delivery of the baby. This implicit bias is an underlying cause for the negativity seen towards extreme prematurity and is presented in this paper. HCP caring for women prior to delivery have a bias towards healthy term babies that involves overestimation of the risks of extreme prematurity, while neonatal staff were biased towards suffering in the neonatal period and paediatricians recognise positivity of outcomes regardless of neurological status of the child. The implicit bias found may explain negativity towards intensive care of periviable neonates. Conclusion Understanding the presence and origins of role specific implicit bias may enable HCP to work together to improve care for parents preparing for the delivery of extremely premature babies.

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Implicit Physician Biases in Periviability Counseling

Cited by 35 publications

References 25 publications

Does women’s place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France

Does women’s place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France

Does women’s place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France.

Exploring implicit bias in the perceived consequences of prematurity amongst health care providers in North Queensland – a constructivist grounded theory study

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