Implicit Physician Biases in Periviability Counseling.

Area of Science:

• Neonatology
• Medical Ethics
• Health Disparities

Background:

• Physicians may hold unconscious racial and socioeconomic biases.
• These biases can impact clinical decision-making, particularly in high-stakes situations.

Purpose of the Study:

• To determine if neonatologists exhibit implicit racial and socioeconomic biases.
• To assess if these biases predict recommendations for extremely premature infants.

Main Methods:

• Nationwide survey with a clinical vignette of a patient at 23 2/7 weeks gestation.
• Physicians randomized to vignettes with varied racial/socioeconomic stimuli.
• Implicit Association Tests (IATs) administered to assess bias.

Main Results:

• IATs revealed implicit preference for white patients (0.48) and higher socioeconomic status (0.73).
• Implicit socioeconomic bias predicted recommending comfort care for high-SES patients (P=.037).
• No significant association found between implicit racial bias and recommendations.

Conclusions:

• Unconscious socioeconomic bias influences recommendations at the limits of viability.
• Physicians with negative socioeconomic bias are less likely to recommend resuscitation for high-SES patients.
• Implicit socioeconomic bias may contribute to neonatal healthcare disparities.