Recommendations to prevent racial discrimination in healthcare delivery: a review of evidence about physician bias toward African American patients with chronic disease and best practices to alleviate institutionalized prejudice as a way to promote health equity. Open Access

Love, DeJa M. (2015)

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Background: Increasingly, data are starting to reveal how physicians unknowingly have bias toward certain patients and how this affects patient care. Physician bias is a type of implicit or unconscious bias, the favoritism of one social group over another based on a person's attitudes or stereotypes that unconsciously affect one's understanding, actions, and decisions. Aims: The goal of this systematic review of literature is to increase public health and clinical medicine's awareness of physician bias toward African American patients with chronic disease with the following aims: Aim 1: To review and summarize the literature on physician bias in the management and treatment of African America's with chronic diseases; and Aim 2: Based on the current evidence, to make recommendations for best practices to prevent racial discrimination in health care delivery as away to alleviate institutionalized prejudice and promote health equity.

Methods: A systematic review of literature was performed in Pub Med for all peer reviewed articles from the last five years on physician bias and chronic disease treatment and care in African American adults.

Results: This search results in 11 articles, which discussed physician bias in the treatment of African American patients with chronic diseases including, hypertension, prostate cancer, osteoarthritis, tumors, diabetes, breast cancer, oral cancer, and stroke. The results reveal that African American patients perceive their physicians have bias toward them and that physicians base clinical treatment decisions based on a patient's race and not always their physiological disease presentation.

Conclusions: Understanding physician bias as a public health concern and human rights issue is a way health providers, clinicians, public health practitioners, and researchers can attempt to address its negative health implications. Implementing debiasing trainings and incorporating consistent discussions to address bias are practical methods public health and clinical medicine can start the process of addressing implicit bias.

Table of Contents

Chapter I: Introduction...2

Introduction and Rationale...2

Problem and Significance Statement...4

Goal Statement and Research Aim...4

Chapter II: Literature Review and Background...6


Health Disparities in African Americans...6

Racism and its Role in Health...9

Physician Bias...11

Outcomes of Physician Bias...13

Physician Bias as a Threat to Public Health and Clinical Medicine...15

Chapter III: Methods...16

Institutional Review Board...17

Methods Overview...17

Inclusion and Exclusion Criteria...17

Study Selection...17

Data Extraction...17

Chapter IV: Results...19

Inclusion and Exclusion Process...20

Race and Clinical Treatment Decisions...20

Race and the Physician-Patient Relationship...22

Characteristics of Reported Studies...24

Chapter V: Discussion, Recommendations and Conclusion...31

Strengths and Weaknesses...34


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