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A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy

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Provider Implicit Racial Bias in Pediatric Sickle Cell Disease.

Siddika S Mulchan^1,2, Christopher B Theriault³, Susan DiVietro^3,4,5

¹Connecticut Children's, University of Connecticut School of Medicine, Farmington, USA. ssmulchan@gmail.com.

Journal of Racial and Ethnic Health Disparities

|July 17, 2024

Summary

Pediatric providers show implicit racial bias, but virtual patient scenarios did not reveal differences in pain care decisions for Black versus White youth with sickle cell disease (SCD). Standardized protocols may mitigate bias in clinical practice.

Keywords:

Health equity Implicit bias Pediatrics Sickle cell disease

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Area of Science:

Medical Ethics
Health Disparities
Pediatric Care

Background:

Implicit racial bias is a concern in healthcare.
Sickle cell disease (SCD) disproportionately affects minority populations, highlighting potential disparities in care.

Purpose of the Study:

To assess implicit racial bias in pediatric providers.
To determine if implicit racial bias impacts clinical decision-making in pediatric sickle cell disease (SCD) pain management using virtual patient (VP) vignettes.

Main Methods:

A cross-sectional study involved 52 pediatric SCD providers.
Providers completed the race Implicit Association Test (IAT) and an explicit bias measure.
Clinical decisions were simulated using VP vignettes of pediatric patients with SCD or cancer pain.

Main Results:

Providers exhibited pro-White implicit bias on the race IAT for both adult and child faces.
Explicit bias measures showed low agreement with negative SCD patient stereotypes.
No significant differences were found in pain treatment decisions based on patient race or diagnosis (SCD vs. cancer).

Conclusions:

Pediatric providers demonstrate implicit racial bias comparable to the general population.
VP vignettes did not show race or diagnosis influencing pain treatment decisions, possibly due to standardized emergency department protocols.
Further research is needed to understand implicit bias in clinical decision-making and the effectiveness of protocols in pediatric SCD pain care.