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Race and Socioeconomic Bias in Pediatric Cardiac Transplantation
Shahnawaz Amdani1, Jennifer Conway2, Jake Kleinmahon3
1Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
Insights
Pediatric heart transplant clinicians show implicit bias, favoring White and higher socioeconomic status (SES) patients. Explicit bias favoring educated individuals was also found, highlighting a need for further research into bias impact and mitigation strategies.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Health Equity
- Medical Ethics
Background:
- Implicit bias in healthcare settings is a growing concern.
- No prior studies have investigated implicit bias among clinicians caring for children with advanced heart failure.
- Understanding these biases is crucial for equitable patient care.
Purpose of the Study:
- To evaluate implicit racial and socioeconomic bias among pediatric heart transplant clinicians.
- To compare implicit and explicit biases within this specific medical group.
Main Methods:
- A cross-sectional survey was administered to pediatric heart transplant clinicians.
- Validated implicit association tests (IATs) for race and socioeconomic status (SES) were used.
- Explicit bias measures and demographic data were also collected.
Main Results:
- Moderate implicit bias favoring White individuals was detected (P < 0.001).
- Strong implicit bias favoring individuals from upper SES was observed (P < 0.001).
- Explicit bias favoring educated individuals was significant, while race and wealth explicit biases were weak.
Conclusions:
- Pediatric heart transplant clinicians exhibit implicit preferences for White and higher SES individuals.
- Explicit preference for educated individuals was also noted.
- Further research is needed to explore the impact of these biases on clinical behavior and to develop effective interventions.
Background:
To date, no studies evaluated implicit bias among clinicians caring for children with advanced heart failure.
Objectives:
This study aims to evaluate implicit racial and socioeconomic bias among pediatric heart transplant clinicians.
Methods:
A cross-sectional survey of transplant clinicians from the Pediatric Heart Transplant Society was conducted between June and August 2021. The survey consisted of demographic questions along with explicit and validated race and socioeconomic status (SES) implicit association tests (IATs). Implicit and explicit biases among survey group members were studied and associations were tested between implicit and explicit measures.
Results:
Of 500 members, 91 (18.2%) individuals completed the race IAT and 70 (14%) completed the SES IAT. Race IAT scores indicated moderate levels of implicit bias (mean = 0.33, d = 0.76; P < 0.001; ie, preference for White individuals). SES IAT scores indicated strong implicit bias (mean = 0.52, d = 1.53; P < 0.001; ie, preference for people from upper SES). There were weak levels of explicit race and wealth bias. There was a strong level of explicit education bias (mean = 5.22, d = 1.19; P < 0.001; ie, preference for educated people). There were nonsignificant correlations between the race and the SES IAT and explicit measures (P > 0.05 for all).
Conclusions:
As observed across other health care disciplines, among a group of pediatric heart transplant clinicians, there is an implicit preference for individuals who are White and from higher SES, and an explicit preference for educated people. Future studies should evaluate how implicit biases affect clinician behavior and assess the impact of efforts to reduce such biases.
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