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Background Despite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers’ implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers’ explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients. Methods Using a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses. Discussion Findings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.

IntroductionAlthough many efforts have been made to reduce racial pain disparities over decades, the pain of black patients is still undertreated. Previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general, and consequently, may contribute to disparities in pain care in particular. That said, there has been limited clinically meaningful progress in eliminating these disparities. This lack of progress is likely because prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. One well-accepted operationalisation of such dyadic processes is behavioural coordination. We hypothesise that the pain of black patients continues to be undertreated because black patients are more likely than white patients to participate in racially discordant medical interactions (ie, seeing other-race providers) and experience disruptions in behavioural coordination. We further hypothesise that disruptions in behavioural coordination will reflect patient and provider factors identified in prior research. We propose to test these hypotheses in the planned surgical context.Methods and analysisUsing a convergent mixed methods research design, we will collect data from at least 15 surgeons and their 150 patients (approximately equal number of black and white patients per surgeon). The data sources will include one surgeon survey, four patient surveys, video- and/or audio-recordings of preoperative consultations and medical chart reviews. The recorded preoperative consultations will be analysed both qualitatively and quantitatively to assess the magnitude and pattern of behavioural coordination between patients and surgeons. Those data will be linked to survey data and data from medical chart reviews to test our hypotheses.Ethics and disseminationEthical approval has been obtained from the Virginia Commonwealth University Institutional Review Board (HM20023574). Findings will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and speaking engagements with clinician stakeholders. We will also share the main findings from this project with patients via a newsletter on completion of the entire project.

BACKGROUND Medical interactions between Black patients and non-Black physicians are less positive and productive than racially concordant ones and contribute to racial disparities in the quality of health care. OBJECTIVE To determine whether an intervention based on the common ingroup identity model, previously used in nonmedical settings to reduce intergroup bias, would change physician and patient responses in racially discordant medical interactions and improve patient adherence. IINTERVENTION Physicians and patients were randomly assigned to either a common identity treatment (to enhance their sense of commonality) or a control (standard health information) condition, and then engaged in a scheduled appointment. DESIGN Intervention occurred just before the interaction. Patient demographic characteristics and relevant attitudes and/or behaviors were measured before and immediately after interactions, and 4 and 16 weeks later. Physicians provided information before and immediately after interactions. PARTICIPANTS Fourteen non-Black physicians and 72 low income Black patients at a Family Medicine residency training clinic. MAIN MEASURES Sense of being on the same team, patient-centeredness, and patient trust of physician, assessed immediately after the medical interactions, and patient trust and adherence, assessed 4 and 16 weeks later. KEY RESULTS Four and 16 weeks after interactions, patient trust of their physician and physicians in general was significantly greater in the treatment condition than control condition. Sixteen weeks after interactions, adherence was also significantly greater. CONCLUSIONS An intervention used to reduce intergroup bias successfully produced greater Black patient trust of non-Black physicians and adherence. These findings offer promising evidence for a relatively low-cost and simple intervention that may offer a means to improve medical outcomes of racially discordant medical interactions. However, the sample size of physicians and patients was small, and thus the effectiveness of the intervention should be further tested in different settings, with different populations of physicians and other health outcomes.

Since the publication of Unequal Treatment in 2003,1 the number of studies investigating the implicit bias of health-care providers and its troubling consequences has increased exponentially. Literature on health disparities focuses primarily on implicit prejudice and few studies have systematically investigated the role of implicit stereotyping in patient care.5 Consequently, implicit bias in previous research generally refers to implicit prejudice. [...]we specify whether we mean implicit prejudice or implicit stereotyping, particularly when we review findings from previous studies. [...]several candidates for the 2020 US presidential election acknowledged the role of health-care providers' implicit bias in racial or ethnic health disparities and have demanded remediation.8 On Oct 2, 2019, California assembly bill no 241 was signed into law,9 mandating implicit bias training for health-care providers, and thereby making it probable that other US medical schools and health organisations will follow suit. A programme that taught college students about five evidence-based strategies for reducing implicit bias (ie, stereotype replacement, counter-stereotypical imaging, individuating, perspective taking, and contact) resulted in lower implicit racial prejudice, as measured by an implicit association test, 8 weeks after the intervention.20 These findings suggest that implicit bias training should also provide health-care providers with concrete strategies to reduce their implicit bias.

Financial behavior disparities across race and gender persist in the United States. Historical and structural factors contribute to such disparities. It is important to understand the psychological mechanisms underlying these disparities to begin to achieve wealth equity. This study addressed one potentially relevant psychological construct: stereotypes about financial behaviors. Using a sample of 114 college students from a large public university, the study explored societally held beliefs about financial behaviors. The results showed that White men were generally viewed as more financially competent than White women, who were viewed as more financially competent than Black men and Black women. Implications for financial education and financial behaviors are discussed.

Objective: Racial/ethnic minorities in the United States not only experience discrimination personally but also witness or hear about fellow in-group members experiencing discrimination (ie, group-level discrimination). The objective of our study was to examine whether the effects of group-level discrimination on mental and physical health are different from those of personal level discrimination among Black Americans by drawing upon social psychology research of the Personal/Group Discrimination Discrepancy. Design and Setting: We conducted a secondary analysis of cross-sectional survey data from a larger study. Participants: One hundred and twenty participants, who self-identified as Black/ African Americans during the laboratory sessions (57.5% women, mean age = 48.97, standard deviation = 8.58) in the parent study, were included in our analyses. Main Predictor Measures: Perceived personal- level discrimination was assessed with five items that were taken from two existing measures, and group-level racial discrimination was assessed with three items. Main Outcome Measures: Self-reported physical and mental health were assessed with a modified version of SF-8. Results: Perceived personal-level racial discrimination was associated with worse mental health. In contrast, perceived group-level racial discrimination was associated with better mental as well as physical health. Conclusions: Perceived group-level racial discrimination may serve as one of several health protective factors even when individuals perceive personal-level racial discrimination. The present findings demonstrate the importance of examining both personal- and group-level experiences of racial discrimination as they independently relate to health outcomes for Black Americans. Ethn Dis. 2016;26:453-460; doi:10.18865/ ed.26.3.453 

Objective Although a number of factors contribute to racial disparities in breast cancer outcomes, perceived discrimination in healthcare may be a key factor that hinders positive interactions and negatively impacts patient outcomes. The goals of our study were to (1) assess the prevalence of perceived discrimination as reported by breast cancer patients and (2) identify factors related to discrimination in women overall as well as by race. Design This study is a secondary analysis of a larger study, “Narrowing the Gaps in Adjuvant Therapy,” where a convenience sample of 359 women completed one telephone survey assessing sociodemographics, and attitudes and beliefs concerning breast cancer treatments and care. Chi-square analysis was used to assess the relationship of categorical variables with perceived discrimination, while the F-test was employed for continuous variables. Logistic regression determined predictors of perceived discrimination, a dichotomous variable (none vs. any). Results A majority of women were Black (58%), privately insured (85%), and had at least a Bachelor’s degree (48%). Discrimination was reported by 32.4% of women, with significantly more Black women reporting discrimination than White women. Insurance status, attitudes toward treatment, and distress factors were significantly related to perceived discrimination. In the logistic model, women who were less trusting of their providers (OR = 0.863 [0.751, 0.993], p  = .021) and Black women (OR = 7.241 [0.751, 0.993], p  = .039) were more likely to report incidences of discrimination. Conclusions Our findings suggest a need to understand Black survivor’s experiences with healthcare. Similarly, future work must focus on identifying ways to improve provider trust amongst breast cancer survivors.

Introduction A growing literature documents the associations between discrimination and health. Emerging evidence suggests that among Hispanic/Latinx immigrants, discrimination leads to the deterioration of health outcomes over time. While sleep has been proposed as an important mediator of the relationship between discrimination and health, few studies have explicitly investigated this pathway, particularly among Hispanic/Latinx populations. Objective To investigate the relationships between racial/ethnic discrimination, sleep, and physical and mental health among Hispanic/Latinx immigrants in the USA. Data and Methods Using data from a parent study of first-generation Hispanic/Latinx immigrants in the southeastern USA, we conducted sequential mediation analyses using the bootstrapping method to investigate whether self-reported sleep duration, sleep quality, and fatigue mediate the relationship(s) between self-reported discrimination, as measured by the discrimination subscale of the Riverside Acculturative Stress Inventory, and self-reported physical and mental health. Results Nocturnal awakenings, fatigue, and sleep quality were statistically significant sequential mediators of the relationship between discrimination and physical health ( b = −.001, SE = .001, CI [−.0027, −.0001]); fatigue alone also mediated this relationship ( b = −.01, SE = .01, CI [−.0279, −.0003]). Nocturnal awakenings, fatigue, and sleep quality were also significant sequential mediators of the relationship between discrimination and mental health ( b = −.001, SE = .001, CI [−.0031, −.0001]). Conclusion Sleep and fatigue play an important role in linking discrimination and health among first-generation Hispanic/Latinx immigrants. The development and implementation of interventions that focus on reducing fatigue among this population could mitigate the effects of unfair treatment on health outcomes.

While the association of racial discrimination and internalizing symptoms in Black individuals is well established, we still have a limited understanding of mechanisms and contextual factors influencing this association, such as sleep and the family context. The present study examined sleep and fatigue as mediators underlying the relationship between racial discrimination and internalizing symptoms within Black adolescent-caregiver dyads. Using data from a larger survey study of risk and resilience in Black adolescents (Mage= 14.36, 49.5% female) and their caregivers (Mage= 39.25, 75.9% female), we used the Actor-Partner Interdependence Model extended Mediation (APIMeM) to test associations of racial discrimination, sleep factors, and internalizing symptoms among 179 dyads. Significant actor effects revealed that sleep disturbance and fatigue independently mediated the association of racial discrimination and internalizing symptoms among adolescents and caregivers. Additionally, partner effects were found, such that adolescents’ experiences of discrimination were indirectly associated with their caregivers’ internalizing symptoms via caregiver fatigue. No direct or indirect effects of caregiver experiences of discrimination on adolescent outcomes were found. The findings highlight the important role sleep and fatigue play in the link between racial discrimination and internalizing symptoms among Black adolescents and adults; and the role that the family context may play in this association. Mental health and sleep interventions for Black individuals should address the impact of racial discrimination on internalizing symptoms, with an emphasis on family-focused interventions.