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Discriminatory Healthcare Experiences and Medical Mistrust in Patients With Serious Illness
Crystal E Brown1, Sandra Y Jackson2, Arisa R Marshall3
1Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., A.R.M.), Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B.), Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Bioethics and Humanities (C.E.B.), School of Medicine, University of Washington, Seattle, Washington, USA.
Context:
Though discrimination in healthcare settings is increasingly recognized, the discriminatory experiences of patients with serious illness has not been well studied.
Objectives:
Describe racial differences in patient-reported experiences with discrimination in the healthcare setting and examine its association with mistrust.
Methods:
We used surveys containing patient-reported frequency of discrimination using the Discrimination in Medical Setting (DMS) and Microaggressions in Health Care Settings (MHCS) scales, mistrust using the Group Based Medical Mistrust (GBMM) scale, and patient characteristics including patient-reported race, income, wealth, insurance status, and educational attainment. Univariable and multivariable linear regression models as well as risk ratios were used to examine associations between patient characteristics including self-reported race, and DMS, MHCS, and GBMM scores.
Results:
In 174 participants with serious illness, racially minoritized patients were more likely to report experiencing discrimination and microaggressions. In adjusted analyses, DMS scores were associated with elements of class and not with race. Black, Native American/Alaskan Native (NA/AN), and multiracial participants had higher MHCS scores compared to White participants with similar levels of income and education. Higher income was associated with lower GBMM scores in participants with similar DMS or MHCS scores, but Black and NA/AN participants still reported higher levels of mistrust.
Conclusion:
In this cross-sectional study of patients with serious illness, discriminatory experiences were associated with worse mistrust in the medical system, particularly for Black and NA/AN participants. These findings suggest that race-conscious approaches are needed to address discrimination and mistrust in marginalized patients with serious illness and their families.
Insights
Patients with serious illness from racial minority groups report more discrimination and mistrust in healthcare. Addressing these disparities requires race-conscious strategies to improve care for marginalized populations.
Area of Science:
- Health Services Research
- Health Disparities
- Patient Experience
Background:
- Discrimination in healthcare is a recognized issue, but less is known about its impact on patients with serious illnesses.
- Understanding patient-reported discriminatory experiences is crucial for improving healthcare equity.
Purpose of the Study:
- To identify racial differences in healthcare discrimination experiences among patients with serious illness.
- To investigate the association between these discriminatory experiences and medical mistrust.
Main Methods:
- Surveys assessed discrimination using the Discrimination in Medical Setting (DMS) and Microaggressions in Health Care Settings (MHCS) scales.
- The Group Based Medical Mistrust (GBMM) scale measured mistrust.
- Regression models analyzed associations between race, socioeconomic factors, and reported discrimination and mistrust.
Main Results:
- Racially minoritized patients with serious illness reported higher rates of discrimination and microaggressions.
- While discrimination scores (DMS) were linked to socioeconomic class, microaggression scores (MHCS) were higher in Black, Native American/Alaskan Native, and multiracial individuals.
- Despite income associations with lower mistrust, Black and Native American/Alaskan Native participants reported higher overall mistrust.
Conclusions:
- Discriminatory experiences correlate with increased medical mistrust, especially among Black and Native American/Alaskan Native patients with serious illness.
- Race-conscious interventions are necessary to combat discrimination and mistrust in marginalized patient populations.
- Addressing these systemic issues is vital for improving healthcare outcomes and patient-provider relationships.
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