Related Experiment Video
Updated: Apr 24, 2026
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Using simulation to assess the influence of race and insurer on shared decision making in periviable counseling
Brownsyne Tucker Edmonds1, Fatima McKenzie, William F Fadel
1From the Departments of Obstetrics and Gynecology (B.T.E, F.M.), and Biostatistics (W.F.F.), Indiana University School of Medicine; Roudebush Veterans Affairs Medical Center (M.S.M.); Department of Psychology (M.P.S.), Indiana University-Purdue University Indianapolis; and Mary Margaret Walther Center for Research and Education in Palliative Care (R.M.F.), IU Simon Cancer Center, Indianapolis, IN; and Division of General Internal Medicine (A.E.B.), Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Introduction:
Sociodemographic differences have been observed in the treatment of extremely premature (periviable) neonates, but the source of this variation is not well understood. We assessed the feasibility of using simulation to test the effect of maternal race and insurance status on shared decision making (SDM) in periviable counseling.
Methods:
We conducted a 2 × 2 factorial simulation experiment in which obstetricians and neonatologists counseled 2 consecutive standardized patients diagnosed with ruptured membranes at 23 weeks, counterbalancing race (black/white) and insurance status using random permutation. We assessed verisimilitude of the simulation in semistructured debriefing interviews. We coded physician communication related to resuscitation, mode of delivery, and steroid decisions using a 9-point SDM coding framework and then compared communication scores by standardized patient race and insurer using analysis of variance.
Results:
Sixteen obstetricians and 15 neonatologists participated; 71% were women, 84% were married, and 75% were parents; 91% of the physicians rated the simulation as highly realistic. Overall, SDM scores were relatively high, with means ranging from 6.4 to 7.9 (of 9). There was a statistically significant interaction between race and insurer for SDM related to steroid use and mode of delivery (P < 0.01 and P = 0.01, respectively). Between-group comparison revealed nonsignificant differences (P = <0.10) between the SDM scores for privately insured black patients versus privately insured white patients, Medicaid-insured white patients versus Medicaid-insured black patients, and privately insured black patients versus Medicaid-insured black patients.
Conclusions:
This study confirms that simulation is a feasible method for studying sociodemographic effects on periviable counseling. Shared decision making may occur differentially based on patients' sociodemographic characteristics and deserves further study.
More Related Videos
Related Concept Videos
02:16Surveys
01:25Strategies for Assessing and Addressing Confounding
Confounding can be addressed at both the design phase of a study and through analytical methods after data...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:14Decision Making: Traditional Method
First, a specific claim about the population parameter is decided based on the research question and is stated in a simple form. Further, an opposing statement to this claim is also stated. These statements can act as null and alternative hypotheses, out of which a null hypothesis would be a...
02:16Stereotype Content Model
01:27Halo Effect