Investigating Healthcare Provider Bias Toward Patients Who Use Drugs Using a Survey-based Implicit Association Test: Pilot Study

Abstract

Objectives: Negative bias against people who use illicit drugs adversely affects the care that they receive throughout the hospital. We hypothesized that emergency providers would display stronger negative bias toward these patients due to life-threatening contexts in which they treat this population. We also hypothesized that negative implicit bias would be associated with negative explicit bias. Methods: Faculty, nurses, and trainees at a midwestern tertiary care academic hospital were invited (June 26, 2019-September 5, 2019) to complete an online implicit association test and explicit bias survey. Results: Mean implicit association test results did not vary across demographics (n = 79). There were significant differences in explicit bias scores between departments regarding whether patients who use drugs deserve quality healthcare access ( P = 0.017). We saw no significant associations between implicit and explicit bias scores. Conclusion: Though limited by sample size, the results indicate that emergency and obstetrics/gynecology providers display more negative explicit bias toward this patient population than other providers.

Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review

“…All 17 observational studies included reported some HCP or trainee SUD stigma (Table 2; see Supplement Digital Appendix 5 at http://links.lww.com/ACADMED/B473 for detailed quantitative results). Among studies that only assessed SUD stigma, stigma was either at the scale midrange 20,22,23,26,28 or lower than the scale midrange 21,26,28,33,43,44 . Among studies with comparison groups, stigma for SUDs was similar or worse than stigma for other chronic conditions.…”

“…We reviewed 201 full-text articles and excluded 167. We included 32 unique articles: 17 prevalence studies (in 17 articles) and 15 intervention studies (in 16 articles) 17–48 . Two articles described shorter- and longer-term outcomes of the same intervention study 24,25 .…”

“…Pre-post Medicine, PA, pharmacy, SW, and nursing students (n = 95) SUD Didactics and interaction with a person with SUD ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Dahl et al, 21 2022 Physicians, nurses, medical residents, medical students, and other (n = 79) SUD Lower stigma than scale midrange…”

“…Among studies that only assessed SUD stigma, stigma was either at the scale midrange 20,22,23,26,28 or lower than the scale midrange. 21,26,28,33,43,44 Among studies with comparison groups, stigma for SUDs was similar or worse than stigma for other chronic conditions. Stigma against SUDs was higher than stigma for other conditions in 2 studies, 18,40 whereas SUD stigma was similar to stigma against other conditions in 4 studies.…”

Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use

“…As Cooper et al ( 2022 ) have observed, skills to reduce implicit bias may best be developed when paired with mindfulness and emotional regulation training. The combination might be especially necessary in preventing stigma based on aspects of behavioral health like illicit drug use that are (problematically) attributed to patient choices or lifestyle and then harmfully legitimized as deserving of judgment (Dahl et al, 2022 ). As with many of the other recommendations implied by our findings, bias and stigma training would likely facilitate better access to services for women with CLS involvement across a range of conditions, not just cervical cancer prevention.…”