Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review
Open accessAbstract
Objectives: Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES. Design: JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open . Data sources: Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers. Eligibility criteria: Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES. Data extraction and synthesis: Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews. Results: Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES. Conclusion: HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.
AI snapshot
Written from the paper’s full text.
TL;DR
This scoping review maps evidence on health professionals’ implicit socioeconomic status (SES) bias and its effects on clinical decision-making for adults with lower SES. Across 67 included publications, most primary studies found an association between SES bias and decision-making, with stereotyping, cognitive load, and intersectionality identified as key influences.
Key findings
- Of 48 included primary research studies, 35 (73%) reported an association between HP SES bias and decision-making, while 13 (27%) did not.
- By professional group, links were found for doctors (23/31, 74%), medical students (3/4, 75%), multiprofessional teams (5/6, 83%), and nurses (3/4, 75%); occupational therapists had 0/1 and psychological therapists 1/2.
- Specialty-specific links were reported in pain assessment/management (7/7, 100%), coronary heart disease (7/8, 87.5%), cancer care (6/7, 86%), and obstetrics/contraception (4/5, 80%).
- Stereotyping and bias can adversely affect decision-making when HPs are fatigued or have high cognitive load; intersectionality can have a cumulative effect, and patient assertiveness may mitigate implicit bias. Four Haider et al studies found high implicit preference for high SES—90.7% of doctors (n=215), 93% of nurses (n=245), and 86% of medical students (n=211)—but no link to decision-making in those studies.
Methods
- JBI scoping review methodology, reported per PRISMA-ScR, with a published a priori protocol; two independent reviewers screened and selected papers.
- Searched Medline, Embase, ASSIA, Scopus, and CINAHL from first available date to March 2023, plus key organisation websites and backward/forward citation chaining; 11,823 publications were screened, 542 reviewed for eligibility, and 67 retained.
- Included studies of all designs; 48 were original research and 19 were reviews, commentaries, or opinion pieces. Data were extracted using an adapted JBI tool and mapped using the PAGER framework.
Limitations
- The paper states that only English-language studies were included due to unfunded status and no translation facility, and that the quality of included literature was not evaluated, consistent with scoping review methodology.
- The paper states that most included publications were from North America and Europe (global north), limiting relevance to other parts of the world, especially the global south.
- The text makes evident that no studies explored implicit bias in pharmacists’ decision-making, and there was insufficient data on occupational therapists and psychological therapists to draw meaningful conclusions.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
44 of 134 cited sources checked · 19 supported · 1 flagged · accuracy not yet measured
- Premisecitation
Care people receive is subject to HP implicit bias arising from perceptions of patients with low SES.
“There is evidence that suggests the care people receive is subject to Health Professionals (HPs) implicit bias arising from perceptions of patients with low SES.10”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [10] source
- Premisecitation
FitzGerald and Hurst's review discusses evidence that social class may invoke more salient bias than bias associated with other characteristics such as race.
“FitzGerald and Hurst’s review16 discusses evidence that social class may invoke more salient bias than bias associated with other characteristics such as race.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] FitzGerald C , Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18. doi:10.1186/s12910-017-0179-8 source
- Findingcitation
In these studies, the high levels of implicit SES bias were not evident in HP's decision-making.
“However, in these studies,27–29 the high levels of implicit SES bias were not evident in HP’s decision-making.”
Quote in the paperSubstantial claim1 of 3 sources checked - Premisecitation
Willems et al found that patients with lower SES had a less positive dialogue with their doctor, characterised by lower levels of information giving, less interactive discourse and a lower level of doctor advice/instruction.
“Willems et al 12 found that patients with lower SES had a less positive dialogue with their doctor, characterised by lower levels of information giving, less interactive discourse and a lower level of doctor advice/instruction.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [12] source
The Conclusions (§4.1; page unavailable) report less information and less participatory communication with lower-SES patients. The Verbal behaviour section (§3.1.1; page unavailable) reports that doctors said they gave these patients less advice, but the review does not establish a lower level of instruction; its conclusion instead describes a more directive consulting style. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Premisecitation
A consensus exists among researchers that the IAT lacks high test-retest reliability in the same individual.
“A consensus exists among researchers with regard to the IAT’s lack of a high test–retest reliability in the same individual.16”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] FitzGerald C , Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18. doi:10.1186/s12910-017-0179-8 source
The Results (Identified studies and Limitations; page not provided) describe how the reviewed studies used the IAT, while the Discussion addresses its relationship to clinical behaviour. None of these passages addresses test–retest reliability within individuals or a researcher consensus about it; searches for those terms and temporal stability found no relevant passage. (LLM, conf=0.72)
Experimental — accuracy not yet measured
- Findingcitation
Goddu et al's study highlights that perceptions and stereotyping among HPs can be triggered prior to in-person meetings with patients through language and words used in medical records or referral letters.
“Goddu et al’s86 study highlights that perceptions and stereotyping among HPs can be triggered prior to in-person meetings with patients through language and words used in medical records or referral letters.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [86] source
The Abstract and Discussion report that stigmatizing language in medical-record notes influenced physicians-in-training’s attitudes toward a hypothetical patient, consistent with impressions forming before an in-person meeting. The study used chart notes, however, and does not establish the same effect for referral letters. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingcitation
Wilson, Anastas et al and Brandao et al's studies highlight stereotyping as an influence in HP behaviour and decision-making.
“Wilson81, Anastas et al 72 and Brandao et al’s82 studies highlight stereotyping as an influence in HP behaviour and decision-making.”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [81] Wilson, 2009, Can patient lifestyle influence the management of pain?, J Clin Nurs source
- cites [72] Anastas, 2020, The unique and interactive effects of patient race, patient socioeconomic status, and provider attitudes on chronic pain care decisions, Ann Behav Med source
- cites [82] Brandao T , Campos L , De Ruddere L , et al . Classism in pain care: the role of patient socioeconomic status on pain medicine. 2019;20:2094–105. doi:10.1093/pm/pnz148 source
The Introduction describes classism as operating through stereotyping, and the limitations section reports experimental evidence that patient socioeconomic status affected nurses’ pain assessments. But the paper says it did not test the mechanisms behind those biases, and the Discussion says its hypotheses about pain-management intentions were not confirmed. It therefore does not establish that stereotyping itself influenced the nurses’ decisions. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Interpretationcitation
HPs make different judgements or decisions about assessment, treatment and care based on who the patient is, as opposed to what they present with.
“HPs make different judgements or decisions about assessment, treatment and care based on who the patient is, as opposed to what they present with.64”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [64] source
- Findingcitation
Brandao et al reported that people with low SES were viewed as less credible during pain assessment by an HP.
“Brandao et al 82 reported that people with low SES were viewed as less credible during pain assessment by an HP.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [82] Brandao T , Campos L , De Ruddere L , et al . Classism in pain care: the role of patient socioeconomic status on pain medicine. 2019;20:2094–105. doi:10.1093/pm/pnz148 source
The Discussion reports that nurses judged the low-SES woman's pain as slightly less credible, but only when distress cues were present. The claim omits that condition and generalizes the finding from a woman assessed by nurses to people with low SES assessed by a health professional. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Findingcitation
Agerström et al found that people with low SES were more likely to receive delays in cardiac arrest care compared with patients with higher SES.
“Agerström et al 78 found that people with low SES were more likely to receive delays in cardiac arrest care compared with patients with higher SES.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [78] source
- Premisecitation
If the HP is engaged in high levels of mental activity, is stressed or has limited time, then this can interrupt, impair or prevent a controlled thoughtful decision.
“However, if the HP is engaged in high levels of mental activity, is stressed or has limited time, then this can interrupt, impair or prevent a controlled thoughtful decision.108”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [108] source
- Findingcitation
Manzer and Bell, Smith-Oka and Shawahna et al's studies identified the adverse impact of stereotyping on HPs assessment and decision-making.
“Manzer and Bell77, Smith-Oka76 and Shawahna et al’s65 studies identified the adverse impact of stereotyping on HPs assessment and decision-making.”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [77] source
- cites [76] Smith-Oka, 2012, Bodies of risk: constructing motherhood in a mexican public hospital, Soc Sci Med source
- cites [65] Shawahna, 2012, Prescribers’ perspectives of the socioeconomic status and important indicators affecting prescribing behavior in a developing country cent, Eur J Med source
The Results (section 3.1) report that physicians considered patients’ socioeconomic status when choosing medicines, and the Discussion (section 4) links stereotyping to clinical decision-making. But the Discussion explicitly says the clinical benefits and risks of differential prescribing were not investigated, so the study does not establish an adverse impact from stereotyping. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Findingcitation
Anastas et al and Wilson's studies both found that people with low SES were often viewed as being untrustworthy and incapable during pain assessment.
“Anastas et al 72 and Wilson’s81 studies both found that people with low SES were often viewed as being untrustworthy and incapable during pain assessment, which led to disproportionate concerns about possible opioid addiction and triggered ‘gate keeping’ behaviours in the HP and this affected pain management decisions.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [72] Anastas, 2020, The unique and interactive effects of patient race, patient socioeconomic status, and provider attitudes on chronic pain care decisions, Ann Behav Med source
The Introduction says providers may worry that low-SES patients will not adhere to treatment or may misuse medication. The Discussion reports more opioid contracts for low-SES patients and suggests that beliefs about misuse contributed to this difference. It does not report that providers viewed them as incapable or untrustworthy, establish addiction concerns as the cause, or describe the contracts as ‘gate keeping’; the study also found that providers were more likely to recommend opioids to low-SES patients. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [81] Wilson, 2009, Can patient lifestyle influence the management of pain?, J Clin Nurs source
- Premisecitation
Vignette studies are an effective way of exploring people's beliefs, perceptions, attitudes, behaviour and biases.
“In addition, vignette studies are an effective way of exploring people’s beliefs, perceptions, attitudes, behaviour and biases.95–98”
Quote in the paperSubstantial claim2 of 4 sources checked- cites [95] Sheringham, 2021, The use of experimental vignette studies to identify drivers of variations in the delivery of health care: a Scoping review, BMC Med Res Methodol source
- cites [96] Chen, 2022, Developing Video vignettes for tourism research: protocol and quality indicators, J Travel Res source
- cites [97] Kunesh, 2019, Understanding disciplinary disproportionality: stereotypes shape pre-service teachers’ beliefs about black boys’ behavior, Urban Educ source
- cites [98] Cheng, 2017, Model minority stereotype: influence on perceived mental health needs of Asian Americans, J Immigr Minor Health source
- Premisecitation
Wealthier people are stereotyped as intelligent and better educated, therefore, more capable than poorer people of lower SES or class.
“In terms of SES or social class, for example, wealthier people are stereotyped as intelligent and better educated, therefore, more capable than poorer people of lower SES or class.26”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [26] Durante, 2017, How social-class stereotypes maintain inequality, Curr Opin Psychol source
The Social-Class Stereotype Content section says high-SES people are attributed intelligence and rich people are stereotyped as more competent than poor people. The Academic Consequences section likewise says rich people are stereotyped as intelligent. Our copy does not establish the additional claim that wealthy people are stereotyped as better educated. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Findingcitation
In Agerström et al's study, highly educated patients (p<0.001) and patients with higher income (p=0.001) were significantly more likely to have their heart rhythm monitored prior to the onset of the cardiac arrest (holding all other variables).
“In this study,78 the results revealed that highly educated patients (p<0.001) and patients with higher income (p=0.001) were significantly more likely to have their heart rhythm monitored prior to the onset of the cardiac arrest (holding all other variables).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [78] source
- Premisecitation
Initial impressions of both the HP and the patient can be corrected through interaction between both parties.
“Initial impressions of both the HP and the patient can be corrected through interaction between both parties.112”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [112] Gopal, 2021, Implicit bias in healthcare: clinical practice, research and decision making, Future Healthc J source
The ‘Definition Practical example’ section describes a clinician retaining an initial diagnosis despite later information from the patient. The Discussion considers clinicians’ awareness of their own biases, but neither passage says that interaction can correct both the healthcare professional’s and the patient’s initial impressions. Searches for initial impressions, mutual interaction, and revised perceptions found no passage establishing that claim. (LLM, conf=0.72)
Experimental — accuracy not yet measured
- Premisecitation
Controlling for SES, people who are of Afro-Caribbean heritage are three times more likely to be diagnosed with diabetes than their counterparts of European heritage.
“For example, there is evidence which shows that controlling for SES, people who are of Afro-Caribbean heritage are three times more likely to be diagnosed with diabetes than their counterparts of European heritage, while people who are lesbian, gay, bisexual, transgender or identify as queer are more likely to have multiple risks for cardiovascular disease than their heterosexual peers.4”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [4] source
The Materials and Methods (Animals; page not provided) describe a study of rats, while the Results (Rats Detect Forepaw Vibration; page not provided) concern responses to sensory stimulation. Searches for Afro-Caribbean heritage, diabetes, socioeconomic status, and European heritage found no passage addressing the claimed comparison. (LLM, conf=0.78)
Experimental — accuracy not yet measured
- Premisecitation
The perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.
“Castaneda‐Guarderas et al 114 and Krupat et al 51 assert that the perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.114”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [114] Castaneda‐Guarderas, 2016, Shared decision making with vulnerable populations in the emergency department, Acad Emerg Med source
The Race and Ethnicity and Socioeconomic Disadvantage sections say that perceived power differentials can inhibit shared decision-making. They also link lower trust to difficulty with shared decision-making, but attribute damage to trust to provider bias or judgmental attitudes; they do not say that power differentials inhibit shared decision-making because they reduce trust. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [51] source
- Findingcitation
One included research paper on mental health found a link between SES and decision-making.
“Two of the included research papers on diabetes64 65 and one on mental health87 found a link between SES and decision-making.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [87] Dougall, 2011, The influence of client socioeconomic status on psychotherapist’s attributional biases and contertransference reactions, Am J Psychother source
- Findingown data
In the included research publications, there were some medical specialities in which three or more research studies explored SES-related implicit bias in HP decision-making.
“In our included research publications, we identified that there were some medical specialities in which there were three or more research studies exploring SES-related implicit bias in HP decision-making (see table 3).”
Quote in the paperNot a substantial claim - Findingown data
Just under two-thirds (n=31) of research papers on HP SES implicit bias and decision-making focused on doctors/physicians.
“It is worth noting that just under two-thirds (n=31)9 18 19 25 28 47 50–74 of research papers on HP SES implicit bias and decision-making focused on doctors/physicians, with significantly less studies focusing on interprofessional or multidisciplinary teams (n=6),75–80 nurses (n=4)29 81–83 and medical students (n=4).27 84–86”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 9 18 19 25 28 47 50–74
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
The association between HP implicit SES bias and their decision-making has been examined using a variety of different research methods.
“Our results indicate that the association between HP implicit SES bias and their decision-making has been examined using a variety of different research methods.”
Quote in the paperNot a substantial claim - Findingown data
Thirty-five of the 48 included primary research studies (73%) reported an association between SES and HP decision-making.
“Thirty-five of the 48 included primary research studies (73%) reported an association between SES and HP decision-making.9 18 19 47 51 52 54–58 60 62–66 68–73 76–79 81–87”
Quote in the paperSubstantial claim - Findingcitation
Two of the included research papers on diabetes found a link between SES and decision-making.
“Two of the included research papers on diabetes64 65 and one on mental health87 found a link between SES and decision-making.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 64 65
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
Half of the studies (50%; n=24) used a vignette approach which used a video recording or combined written case exemplars, scenarios and images of different types of people.
“However, half of the studies (50%; n=24)19 25 27 29 44 47 51 53 54 57 60 64 67 68 71 72 79 82–84 86 88 89 used a vignette approach which used a video recording or combined written case exemplars, scenarios and images of different types of people.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 19 25 27 29 44 47 51 53 54 57 60 64 67 68 71 72 79 82–84 86 88 89
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
In obstetric/contraception care, 80% (n=4) of studies reported a link between implicit SES bias and HP decision-making.
“In obstetric/contraception care, 80% (n=4) reported a link between implicit SES bias and HP decision-making.62 75–77”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 62 75–77
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Three of the nine papers that explored multiple conditions detected a link between SES and decision-making.
“Three of the nine papers that explored multiple conditions detected a link between SES and decision-making.58 65 66”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 58 65 66
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
Thirteen papers did not detect any SES-related bias in HP decision-making.
“Thirteen papers did not detect any SES-related bias in HP decision-making.25 27–29 44 53 59 61 67 74 80 88 89”
Quote in the paperNot a substantial claim - Findingown data
Every included study (n=7; 100%) on pain assessment and/or management reported a link between decision-making and SES.
“Every included study (n=7; 100%) on pain assessment and/or management60 71 72 79 81–83 reported a link between decision-making and SES.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 60 71 72 79 81–83
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
Regardless of the research method used, in most studies, the information provided to participants with regard to SES was predicated on the patient's visual appearance such as clothes or how they were described which provided insight into their profession and/or education.
“Regardless of the research method used, in most studies, the information provided to the participants with regard to SES was predicated on the patient’s visual appearance such as the clothes that they were wearing, or how they were described which provided an insight into their profession and or education.”
Quote in the paperNot a substantial claim - Findingown data
All but one study (n=7; 87.5%) exploring coronary heart disease detected disparities in HP decision-making related to SES.
“More than three-quarters of the studies involving cancer care (n=6; 86%)19 51 57 69 70 84 and all but one study (n=7; 87.5%)9 18 55 56 68 78 85 exploring coronary heart disease (CHD) detected disparities in HP decision-making related to SES.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 9 18 55 56 68 78 85
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
The two studies exploring SES and decision-making in trauma care did not detect a link between SES and decision-making.
“The two studies exploring SES and decision-making in trauma care did not detect a link between SES and decision-making.28 67”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 28 67
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
More than three-quarters of the studies involving cancer care (n=6; 86%) detected disparities in HP decision-making related to SES.
“More than three-quarters of the studies involving cancer care (n=6; 86%)19 51 57 69 70 84 and all but one study (n=7; 87.5%)9 18 55 56 68 78 85 exploring coronary heart disease (CHD) detected disparities in HP decision-making related to SES.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 19 51 57 69 70 84
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
The HPs in the Brown study considered confidentiality to be less of a priority for the women with low SES because their social position was less important.
“The HPs in the Brown study75 considered confidentiality to be less of a priority for the women with low SES because their social position was less important.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [75] source
- Findingcitation
Several papers suggest that the contribution of cognitive load, stress and limited time restraints impact on the HP's motivation to suppress implicit bias when making decisions.
“Several papers11 75 106 107 suggest that the contribution of cognitive load, stress and limited time restraints impact on the HP’s motivation to suppress implicit bias when making decisions.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 11 75 106 107
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Brown discovered that HPs took greater effort to ensure the confidentiality of the HIV diagnosis was protected for women with high SES.
“Brown75 discovered that HPs took the greater effort to ensure the confidentiality of the HIV diagnosis was protected for women with high SES.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [75] source
- Findingown data
A formal SES or deprivation measure was used in only three of the studies included in this review.
“A formal SES or deprivation measure was used in only three of the studies included in this review.9 66 69”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 9 66 69
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Stereotyping and bias were also reported in maternity and family planning studies.
“Stereotyping and bias were also reported in maternity and family planning studies.65 76 77”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 65 76 77
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingreasoning
There is evidence to suggest that HPs rely on implicit messages to 'fill the gaps' in comprehensive assessment when time and effortful thought are limited or prevented.
“There is evidence to suggest that HPs rely on implicit messages to ‘fill the gaps’ in comprehensive assessment when time and effortful thought are limited or prevented.”
Quote in the paperSubstantial claim - Findingcitation
There is also evidence that shows stereotyping can assist in coping with the pressures of HP practice.
“There is also evidence that shows stereotyping can assist in coping with the pressures of HP practice.109”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [109] Kirkham, 2002, Stereotyping as a professional defence mechanism, Br J Midwifery source
- Findingcitation
Brown discovered that this bias tended to be activated when staff were overburdened and/or where health services were poorly resourced.
“Brown75 discovered that this bias tended to be activated when staff were overburdened and/or where health services were poorly resourced.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [75] source
- Findingreasoning
A recurring theme is the reported influence of HP workload on implicit bias and decision-making.
“A recurring theme is the reported influence of HP workload on implicit bias and decision-making.”
Quote in the paperNot a substantial claim - Findingcitation
In both these studies, patient assertiveness led to more careful diagnostic testing for people who may have been otherwise disadvantaged because of their SES.
“In both these studies,51 56 patient assertiveness led to more careful diagnostic testing for people who may have been otherwise disadvantaged because of their SES.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 51 56
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingreasoning
Our results show that intersectionality can have a powerful cumulative effect on HP assessment and subsequent decision-making.
“Our results show that intersectionality can have a powerful cumulative effect on HP assessment and subsequent decision-making.”
Quote in the paperSubstantial claim - Findingcitation
A smaller number of papers recommend that any such policies, guidelines and best practice statements should be constructed with mindfulness of implicit bias.
“A smaller number of papers recommend that any such policies, guidelines and best practice statements should be constructed with mindfulness of implicit bias.75 117”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 75 117
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Denberg et al explored race and social vulnerability for men with localised prostate cancer and discovered that the higher the perceived patient vulnerability by the HP, the more likely they were to opt for 'watchful waiting' as opposed to active treatment.
“Denberg et al 57 explored race and social vulnerability for men with localised prostate cancer and discovered that the higher the perceived patient vulnerability by the HP, the more likely they were to opt for ‘watchful waiting’ as opposed to active treatment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [57] source
- Findingcitation
Patient assertiveness can lead to more careful diagnostic testing for people who may have been otherwise disadvantaged because of their SES.
“Patient assertiveness can lead to more careful diagnostic testing for people who may have been otherwise disadvantaged because of their SES.56”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [56] Barnhart, 2006, Can non-medical factors contribute to disparities in coronary heart disease treatment, J Health Care Poor Underserved source
- Findingcitation
Our results about the complex intersection of SES and other factors such as race are consistent with wider evidence from other studies.
“Our results about the complex intersection of SES and other factors such as race are consistent with wider evidence from other studies.”
Quote in the paperNot a substantial claim - Findingcitation
Barnhart et al explored non-medical reasons for disparities in coronary heart disease treatments and discovered that if patients with low SES adopted a health-assertive manner, then their treatment recommendations (revascularisation) more closely mirrored patients who had high SES.
“Barnhart et al 56 explored non-medical reasons for disparities in coronary heart disease treatments and discovered that if patients with low SES adopted a health-assertive manner, then their treatment recommendations (revascularisation) more closely mirrored patients who had high SES.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [56] Barnhart, 2006, Can non-medical factors contribute to disparities in coronary heart disease treatment, J Health Care Poor Underserved source
- Findingnone given
Health professionals often hold implicit bias of people with low SES.
“This review indicates that HPs often hold implicit bias of people with low SES”
Quote in the paperSubstantial claim - Findingcitation
Men who were deemed to have a low income, were widowed or were characterised as being black by HPs, were the least likely to be referred for radical prostatectomy.
“For example, men who were deemed to have a low income, were widowed or were characterised as being black by HPs, were the least likely to be referred for radical prostatectomy.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [57] source
- Premisecitation
SES is a key causative and contributory factor to disparities and inequities in morbidity and mortality in many nations.
“Socioeconomic status (SES), a social determinant of health, is a key causative and contributory factor to disparities and inequities in morbidity as well as mortality in many nations.1–3”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [1] Marmot M . Fairer society healthy lives: the marmot review. Strategy review of health inequalities in england, 2010. Available: https://www.gov.uk/research-for-development-outputs/fair-society-healthy-lives-the-marmot-review-strategic-review-of-health-inequalities-in-england-post-2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [2] Black D . London Pengiun; Inequalities in helath: the black report, 1980. Available: https://www.sochealth.co.uk/national-health-service/public-health-and-wellbeing/poverty-and-inequality/the-black-report-1980/the-origin-of-the-black-report/
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [3] source
- Premisecitation
HPs are susceptible to multiple implicit biases relating to different characteristics such as SES, gender, weight, age and ethnicity in their decision-making.
“HPs are susceptible to multiple implicit biases relating to different characteristics such as SES, gender, weight, age and ethnicity in their decision-making.11 12 16”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 11 12 16
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Healthcare professionals are more likely to use discrete measures of SES, rather than more robust empirical measures, to inform their perceptions of patients in everyday practice.
“In other words, we assert that healthcare professionals are more likely to use discrete measures of SES, rather than more robust empirical measures to inform their perceptions of patients in everyday practice.17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Maule, 2002, Heuristics, biases and strategic decision making, Psychologist
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
SES-related healthcare disparities are influenced by how a person's SES is perceived by themselves and others.
“Therefore, SES-related healthcare disparities are influenced by how a person’s SES is perceived by themselves and others.5 6”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 5 6
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationnone given
HP implicit bias may be mitigated through the assertiveness of the patient with low SES.
“HP implicit bias may be mitigated through the assertiveness of the patient with low SES.”
Quote in the paperNot a substantial claim- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
- Interpretationown data
HP decision-making is at times influenced by non-medical factors for people of low SES.
“HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities.”
Quote in the paperSubstantial claim- Rests on an assumption: The quality of the included studies does not materially affect the review's conclusions.
- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
- Interpretationreasoning
This result suggests that not all implicit bias leads to disparities in decision-making.
“This result suggests that not all implicit bias leads to disparities in decision-making.”
Quote in the paperSubstantial claim - Interpretationnone given
There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making.
“There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making.”
Quote in the paperNot a substantial claim- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
- Interpretationreasoning
Assumptions are made based on implicit bias and stereotyping.
“HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities.”
Quote in the paperSubstantial claim- Rests on an assumption: The quality of the included studies does not materially affect the review's conclusions.
- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
- Interpretationreasoning
Implicit bias and stereotyping compound or exacerbate health inequalities.
“HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities.”
Quote in the paperSubstantial claim- Rests on an assumption: The quality of the included studies does not materially affect the review's conclusions.
- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
- Interpretationreasoning
In over two-thirds of the research papers reviewed, HP decision-making about assessment, investigations, treatment or care was influenced by a person's SES.
“Meaning that in over two-thirds of the research papers reviewed HP decision-making about assessment, investigations, treatment or care was influenced by a person’s SES.”
Quote in the paperSubstantial claim- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
- Premisecitation
Despite debate, the IAT is the most widely used measure of implicit race and ethnicity bias in healthcare.
“Despite this lively debate about the relative merits of IAT, it is the most widely used measure of implicit race and ethnicity bias in healthcare.16 31 33”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 16 31 33
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationown data
The empirical evidence at hand indicates that more is known about doctors/physicians' implicit SES biases and its consequences with regard to their decision-making than other professions.
“The empirical evidence at hand indicates that more is known about doctors/physicians’ implicit SES biases and its consequences with regard to their decision-making than other professions.”
Quote in the paperSubstantial claim - Premisecitation
Vignette studies are adept at establishing judgement and decision-making in a variety of professions, which have a high level of applicability and generalisability about how HPs undertake their work on a day-to-day basis.
“Vignette studies are adept at establishing judgement and decision-making in a variety of professions, which have a high level of applicability and generalisability about how HPs undertake their work on a day-to-day basis.94 95”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 94 95
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
The results of this scoping review support the view that proxy measures for SES, although with their limitations, can provide useful insights into HP implicit bias and its consequences for their clinical decision-making about patient care.
“The results of this scoping review support our view that proxy measures for SES, although with their limitations, can provide useful insights into HP implicit bias and its consequences for their clinical decision-making about patient care.17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Maule, 2002, Heuristics, biases and strategic decision making, Psychologist
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
SES-related stigma and bias can unwittingly be transmitted among HPs through the words and language that are used to characterise the person receiving care as well as to describe their lived experience.
“This suggests that SES-related stigma and bias can unwittingly be transmitted among HPs through the words and language that are used to characterise the person receiving care as well as to describe their lived experience.”
Quote in the paperSubstantial claim - Premisecitation
In these circumstances, stereotyping is used as an energy-saving mechanism that allows for intellectual shortcuts in decision-making that feel comfortable because they fit with what we think we know.
“In these circumstances, stereotyping is used as an energy-saving mechanism that allows for intellectual shortcuts in decision-making that feel comfortable because they fit with what we think we know.11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Veesart A , Barron A . Unconscious bias: Is it impacting your nursing care? Nurs Made Incred Easy 2020;47–9. doi:10.1097/01.NME.0000653208.69994.12 source
- Interpretationreasoning
Spending less time with patients with low SES may be perceived as helping to 'move clinics along' because of the HP assumption that some people will not need as long as other people in clinic.
“Spending less time with patients with low SES may be perceived as helping to ‘move clinics along’ because of the HP assumption that some people will not need as long as other people in clinic.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Implicit bias of people with low SES may compound or exacerbate health inequalities.
“and may compound or exacerbate health inequalities.”
Quote in the paperSubstantial claim - Interpretationreasoning
Implicit bias of people with low SES can result in stereotyping.
“which can result in stereotyping”
Quote in the paperSubstantial claim - Premisecitation
This interaction requires motivation for one or other party.
“This interaction, however, requires motivation for one or other party.51”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] source
- Interpretationreasoning
A key message arising from this scoping review for health services, professional bodies and policy-makers is that HPs have SES-related implicit biases that influence how they organise and deliver patient care.
“A key message arising from this scoping review for health services, professional bodies and policy-makers is that HPs have SES-related implicit biases that influence how they organise and deliver patient care.”
Quote in the paperSubstantial claim - Interpretationreasoning
The fact that only articles published in English were included means that relevant works in other languages will have been omitted from this review.
“The fact that only articles published in English were included, means that relevant works in other languages will have been omitted from this review.”
Quote in the paperSubstantial claim - Interpretationreasoning
The result of this scoping review provided a limited insight into other parts of the world, particularly those where English is not the native language, as well as in places where the organisation and delivery of healthcare take place in systems that are distinct from those in North America and/or Europe.
“Consequently, the result of this scoping review provided a limited insight into other parts of the world, particularly those where English is not the native language, as well as in places where the organisation and delivery of healthcare take place in systems that are distinct from those in North America and/or Europe.”
Quote in the paperNot a substantial claim - Premisecitation
Initial impressions of warmth and competence can be adjusted through dialogue during the assessment and decision-making process.
“Initial impressions of warmth and competence can be adjusted through dialogue during the assessment and decision-making process.”
Quote in the paperNot a substantial claim - Premisecitation
A patient who demonstrates existing knowledge and has an active or assertive manner in dialogue with the HP can influence the HP decision-making by altering the HPs assumptions related to the warmth or competence of the patient.
“In the same way, a patient who demonstrates existing knowledge and has an active or assertive manner in dialogue with the HP can influence the HP decision-making by altering the HPs assumptions related to the warmth or competence of the patient.51”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] source
- May combine two claims. 51
- Classified as probably not a substantial claim. 44
May combine two claims.
Findingown dataSignificantly fewer studies focused on interprofessional or multidisciplinary teams (n=6), nurses (n=4), and medical students (n=4).
“It is worth noting that just under two-thirds (n=31)9 18 19 25 28 47 50–74 of research papers on HP SES implicit bias and decision-making focused on doctors/physicians, with significantly less studies focusing on interprofessional or multidisciplinary teams (n=6),75–80 nurses (n=4)29 81–83 and medical students (n=4).27 84–86”
Quote in the paperSubstantial claim3 of 8 sources checked- cites [75] source
- cites [76] Smith-Oka, 2012, Bodies of risk: constructing motherhood in a mexican public hospital, Soc Sci Med source
- cites [77] source
- cites [78] source
The Methods (The Swedish Register of Cardiopulmonary Resuscitation; Selection of patients, pages unavailable) describe a study of patient-level cardiac-arrest records, not a study focused on interprofessional or multidisciplinary teams. The Discussion (Clinical implications, page unavailable) mentions cardiac-arrest teams only as possible recipients of future equality training. This paper therefore does not fit the team-focused category for which it is cited; it also does not establish the citing review’s count of six studies. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured - cites [79] Bernardes, 2021, Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship, Pain source
- cites [80] Bruno, 2022, Is sociodemographic status associated with empathic communication and decision quality in diabetes care?, J Gen Intern Med source
- cites 29 81–83
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites 27 84–86
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPeople with lower SES tend to have a shorter life expectancy and worse health-related outcomes compared with more affluent people.
“There is a wide range of robust empirical evidence from many settings which indicates that people with lower SES tend to have a shorter life expectancy and worse health-related outcomes in comparison to more affluent people.1–4”
Quote in the paperNot a substantial claim1 of 4 sources checked- cites [1] Marmot M . Fairer society healthy lives: the marmot review. Strategy review of health inequalities in england, 2010. Available: https://www.gov.uk/research-for-development-outputs/fair-society-healthy-lives-the-marmot-review-strategic-review-of-health-inequalities-in-england-post-2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [2] Black D . London Pengiun; Inequalities in helath: the black report, 1980. Available: https://www.sochealth.co.uk/national-health-service/public-health-and-wellbeing/poverty-and-inequality/the-black-report-1980/the-origin-of-the-black-report/
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [3] source
- cites [4] source
The Results passages concern sensory-cortex activity and stimulus detection, while Materials and Methods > Animals describes a study in rats; no page numbers are available in our copy. Searches for socioeconomic status, life expectancy, income, mortality, and related health outcomes found no passage addressing the claimed comparison between people of lower and higher SES. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Classified as probably not a substantial claim. May combine two claims.
PremisecitationFitzGerald and Hurst's systematic review indicated that biases are likely to influence diagnosis, treatment decisions and levels of patient care.
“FitzGerald and Hurst’s systematic review16 explored HPs implicit biases relating to race/ethnicity, age, gender and SES and indicated that biases are likely to influence diagnosis, treatment decisions and levels of patient care.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] FitzGerald C , Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18. doi:10.1186/s12910-017-0179-8 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe scoping review was conducted using JBI methodology and reported in line with PRISMA-ScR guidelines.
“We conducted a scoping review using Joanna Briggs Institute (JBI) methodology39 40 as set out in our a priori published protocol13 and reported our results in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols and Scoping Reviews (PRISMA-ScR) guidelines.41 42”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites 39 40
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [13] Job, 2022, Health professional’s implicit bias of adult patients with low socioeconomic status (SES) and its effects on clinical decision-making: a Scoping review protocol, BMJ Open source
- cites 41 42
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationThree of these studies reported that 90.7% of doctors (n=215), 93% of nurses (n=245) and 86% of medical students (n=211) demonstrated an implicit preference towards people with High SES.
“Three of these studies reported that 90.7% of doctors (n=215)28, 93% of nurses (n=245)29 and 86% of medical students (n=211)27 demonstrated an implicit preference towards people with High SES.”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [28] source
- cites [29] source
- cites [27] source
The Results report an implicit upper-class preference in 174 of 202 students with complete surveys (86%). They also say 211 students volunteered, but only 202 completed surveys, so n=211 is not the denominator for the reported 86%. The doctors and nurses figures are attached to other citations, not this paper. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningOnly publications in English were included because the study was unfunded with no facility for translation.
“We only included publications in English as this was an unfunded study with no facility for translation.13”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [13] Job, 2022, Health professional’s implicit bias of adult patients with low socioeconomic status (SES) and its effects on clinical decision-making: a Scoping review protocol, BMJ Open source
May combine two claims.
PremisecitationSelf-awareness of one's own prejudice and bias is important when making decisions, but self-awareness is diminished when the HP is busy and does not have sufficient head space to mitigate the impact of potential implicit bias.
“Self-awareness of one’s own prejudice and bias is important when making decisions, but self-awareness is diminished when the HP is busy and does not have sufficient head space to mitigate the impact of potential implicit bias.108”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [108] source
May combine two claims.
InterpretationcitationSES-related stereotypes seem to be a contributing factor that maintains health inequalities, given that HP decision-making appears to lead to unwarranted variations in care and treatment.
“Consequently, SES-related stereotypes seem to be a contributing factor that maintains health inequalities, given that HP decision-making appears to lead to unwarranted variations in care and treatment.64”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [64] source
The Results section on diagnosed diabetes with emerging foot neuropathy reports that lower-SES patients with identical symptoms were less likely to receive several recommended examinations and might be diagnosed later. The Discussion links variable physician decisions to health care disparities. The paper does not establish that SES-related stereotypes caused those decisions. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationWarmth is evaluated first because it predicts future behaviour; capability is judged more slowly as it reflects the other person's ability to act competently.
“Warmth is evaluated first because it predicts future behaviour; capability is judged more slowly as it reflects the other person’s ability to act competently.26”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [26] Durante, 2017, How social-class stereotypes maintain inequality, Curr Opin Psychol source
The Social-Class Stereotype Content and Social-Class Stereotypes’ Academic Consequences sections discuss warmth, trustworthiness, and competence as stereotype dimensions. Neither those passages nor searches for evaluation order, future behaviour, and slower capability judgments address the claimed timing or its explanation. (LLM, conf=0.72)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationHeart rhythm monitoring was significantly associated with less delay, shorter duration, increased immediate survival and 30-day survival.
“Heart rhythm monitoring was significantly associated with less delay, shorter duration, increased immediate survival and 30-day survival.78”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [78] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSES can be signalled in many ways, the way a person dresses, their mannerisms or their accent and these cues lead to behaviour changes that impact on the interaction between people.
“SES can be signalled in many ways, the way a person dresses, their mannerisms or their accent and these cues lead to behaviour changes that impact on the interaction between people.26”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [26] Durante, 2017, How social-class stereotypes maintain inequality, Curr Opin Psychol source
Probably not a substantial claim: may not pass S2 (checkable).
PremisecitationDecision-making is ideally a controlled process which involves making intentional, conscious and effortful thought.
“Decision-making is ideally a controlled process which involves making intentional, conscious and effortful thought.108”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [108] source
The Abstract defines controlled processes as involving intentional, conscious, and effortful thought. But Hypothesis 1 says the ideal for clinical decision-making is to shift strategically between automatic and controlled processes when warranted, not to make every decision through controlled processing. (LLM, conf=0.87)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationIn Anastas et al and Wilson's studies, this led to disproportionate concerns about possible opioid addiction and triggered 'gate keeping' behaviours in the HP, affecting pain management decisions.
“Anastas et al 72 and Wilson’s81 studies both found that people with low SES were often viewed as being untrustworthy and incapable during pain assessment, which led to disproportionate concerns about possible opioid addiction and triggered ‘gate keeping’ behaviours in the HP and this affected pain management decisions.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [72] Anastas, 2020, The unique and interactive effects of patient race, patient socioeconomic status, and provider attitudes on chronic pain care decisions, Ann Behav Med source
The Discussion (page not provided) reports that providers were more likely to use opioid contracts with low-SES patients and suggests that beliefs about opioid misuse likely contributed. It does not establish that providers viewed these patients as incapable, specifically feared addiction, or engaged in broader ‘gate keeping’ behaviours. The paper also reports that providers were more likely to recommend opioids to low-SES patients. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [81] Wilson, 2009, Can patient lifestyle influence the management of pain?, J Clin Nurs source
May combine two claims.
InterpretationcitationThe intersectional interaction between different factors is arguably a reflection of the continuous nature of perceived warmth and capability matrix as previously described in the SCM, but the outcome for the patient can be bleaker when racial and class biases stereotypes overlap.
“The intersectional interaction between different factors is arguably a reflection of the continuous nature of perceived warmth and capability matrix as previously described in the SCM, but the outcome for the patient can be bleaker when racial and class biases stereotypes overlap.26”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [26] Durante, 2017, How social-class stereotypes maintain inequality, Curr Opin Psychol source
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable, 1 not checked. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationStereotypes and prejudices are stackable and the proclivity towards discriminatory attitudes, tendencies and behaviours rises as the perceived vulnerability of the person seeking or receiving care increases.
“Stereotypes and prejudices are stackable and the proclivity towards discriminatory attitudes, tendencies and behaviours rises as the perceived vulnerability of the person seeking or receiving care increases.16”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] FitzGerald C , Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18. doi:10.1186/s12910-017-0179-8 source
The Discussion (page not supplied) describes intersectionality and reports an example in which bias appeared against low-SES Latina patients but not high-SES Latina patients. That supports the idea that disadvantages can interact. The Results (page not supplied) say these interactions are varied, however; the review does not establish that discriminatory attitudes or behaviours consistently rise as a patient's perceived vulnerability increases. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationHealth inequalities only endure because of a lack of insight or willingness to address social injustice, social indifference, an ideological stance or a vacuum of leadership.
“Health inequalities only endure because of a lack of insight or willingness to address social injustice, social indifference, an ideological stance or a vacuum of leadership.115”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [115] Hassan, 2023, Minding the gap: the importance of active facilitation in moving boundary objects from in-theory to in-use as a tool for knowledge mobilisation, SSM Qual Res Health source
The Background (p. 1) attributes the persistence of health inequalities to an inability or unwillingness to act on entrenched social injustices, citing ideology, lack of leadership and societal indifference. It does not say these are the only reasons inequalities endure, so the citing sentence's “only” overstates the source. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
InterpretationcitationHP decision-making is also subject to non-medical factors, as assumptions are often made about the care of people of low SES based on bias and stereotyping, which causes or exacerbates health inequalities that can adversely affect patient's clinical outcomes.
“HP decision-making is also subject to non-medical factors, as assumptions are often made about the care of people of low SES based on bias and stereotyping, which causes or exacerbates health inequalities that can adversely affect patient’s clinical outcomes.64”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [64] source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationFitzGerald and Hurst's systematic review which explored implicit bias in healthcare professionals, highlighted how perceptions relating to race, SES and gender intersect but also interact in complex ways.
“FitzGerald and Hurst’s16 systematic review which explored implicit bias in healthcare professionals, highlighted how perceptions relating to race, SES and gender intersect but also interact in complex ways.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] FitzGerald C , Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017;18. doi:10.1186/s12910-017-0179-8 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPeople who are lesbian, gay, bisexual, transgender or identify as queer are more likely to have multiple risks for cardiovascular disease than their heterosexual peers.
“For example, there is evidence which shows that controlling for SES, people who are of Afro-Caribbean heritage are three times more likely to be diagnosed with diabetes than their counterparts of European heritage, while people who are lesbian, gay, bisexual, transgender or identify as queer are more likely to have multiple risks for cardiovascular disease than their heterosexual peers.4”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [4] source
The Materials and Methods (Animals; page unavailable) describes a study of five female rats, and the Discussion (page unavailable) addresses neural beta-bursts and stimulus detection. Searches for LGBTQ identity, heterosexual peers, and cardiovascular risk factors found no passage addressing the claimed comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationGenuine changes in behaviour and improvement in any human endeavour can only arise when there is a genuine acceptance of the truth of the situation, specifically facts and issues at hand, including any implicit biases, with a concomitant theory of action.
“genuine changes in behaviour and improvement in any human endeavour can only arise when there is a genuine acceptance of the truth of the situation, specifically facts and issues at hand, including any implicit biases, with a concomitant theory of action.119”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [119] Samuriwo, 2022, Interprofessional collaboration-time for a new theory of action?, Front Med (Lausanne) source
In “Toward a New Theory of Action” (page unavailable), the paper says meaningful change arises when people understand things as experienced and have a theory of action reflecting their reality. Its discussion concerns improving interprofessional collaboration in healthcare; it does not establish that change in any human endeavour can *only* occur through accepting facts and implicit biases. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA motivated HP who offers more time, seeks the input of the patient and consciously considers equality and/or equity can build a dialogue with the person based on 'what matters most to them'.
“A motivated HP who offers more time, seeks the input of the patient and consciously considers equality and/or equity can build a dialogue with the person based on ‘what matters most to them’.103”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [103] Fiske, 2015, Intergroup biases: a focus on stereotype content, Curr Opin Behav Sci source
The Overview and Conclusion discuss stereotype content, prejudice and discriminatory tendencies, not how health professionals build patient dialogue. Searches for patient input, additional time, equality or equity, and ‘what matters most’ found no passage addressing the claimed approach. Page numbers were not available in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe review screened 11,823 publications across different decades.
“In our search strategy, we purposively cast a wide net to capture all relevant published papers because of the complexity of defining SES and in total, we screened 11 823 publications across different decades.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationFour papers by Haider et al did not find a link between SES and decision-making but detected high levels of implicit favourable bias towards people with high SES, in doctors, nurses and medical students.
“Interestingly, four papers by Haider et al 27–29 67 did not find a link between SES and decision-making but detected high levels of implicit favourable bias towards people with high SES, in doctors,28 67 nurses29 and medical students.27”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 27–29 67
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationSome studies (n=6) used the IAT to gather data regarding participants' favourable bias as a precursor to vignette examination of decision-making.
“Some studies (n=6)27–29 67 68 72 used the IAT to gather data regarding the participants’ favourable bias as a precursor to vignette examination of decision-making.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 27–29 67 68 72
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data542 studies were reviewed for eligibility and 67 publications were retained for inclusion.
“We reviewed 542 studies for eligibility and retained 67 publications for inclusion in the scoping review.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data48 of the 67 included papers (72%) reported original research; the remaining were commentaries or opinion pieces (n=15) and reviews (n=4).
“48 of the 67 included papers (72%) reported on original research while the remaining papers were commentaries or opinion pieces (n=15) and reviews (n=4) about aspects of SES and HP decision-making.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingreasoningThe number of papers exploring decisions made by non-medical HPs gained interest in the literature after 2008.
“The number of papers exploring decisions made by non-medical HPs gained interest in the literature after 2008 and reflects the changing landscape of healthcare decision-making, and the extended role of Nurses and Allied HPs.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataFor the other specialties listed in table five, a single research paper was included: asthma, dermatology, kidney transplantation, palliative care and sickle cell disease.
“For the other specialties listed in table five a single research paper was included; asthma73, dermatology63, kidney transplantation52, palliative care47 and sickle cell disease.86”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 73 63 52 47 86
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationIn these studies HPs considered women with low SES to be untrustworthy, bad mothers and/or promiscuous, as well as lacking capacity to make sensible decisions about planning future pregnancies.
“In these studies HPs considered women with low SES to be untrustworthy, bad mothers and/or promiscuous, as well as lacking capacity to make sensible decisions about planning future pregnancies.65 76 77”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 65 76 77
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Findingown dataIncluded papers used proxy measures such as occupation/employment (n=15), education (n=14), income/finances (n=11), appearance/dress (n=7), health insurance (n=3).
“Included papers used proxy measures such as occupation/employment (n=15),25 27 29 47 53–55 65 68 71 72 81 84 85 89 education (n=14),9 28 52 58 59 61–63 70 78–80 82 89 income/finances (n=11),9 18 57 69 71 72 74–76 78 80 appearance/dress (n=7),19 25 53 64 83 85 88 health insurance (n=3).18 19 56”
Quote in the paperSubstantial claim0 of 3 sources checked- cites 25 27 29 47 53–55 65 68 71 72 81 84 85 89
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites 9 28 52 58 59 61–63 70 78–80 82 89
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites 9 18 57 69 71 72 74–76 78 80
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationMcKinlay et al explored non-medical influences on HP decision-making for patients with coronary heart disease and found that discriminatory attitudes and behaviours were linked to the patient's age, perceived level of income and insurance status.
“McKinlay et al 18 explored non-medical influences on HP decision-making for patients with coronary heart disease and found that discriminatory attitudes and behaviours were linked to the patient’s age, perceived level of income and insurance status.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18] source
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Findingnone givenResearch in this area has grown and evolved significantly and the disciplinary focus has recently shifted from doctors to the wider healthcare team.
“Research in this area has grown and evolved significantly and the disciplinary focus has recently shifted from doctors to the wider healthcare team.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationManderbacka exploration of decision-making in relation to 'white collar' and 'blue collar' patients found that doctors were more likely to take a 'doctor-centred model' for communication, assessment and decision-making with patients from a 'blue collar' background but tended to adopt a 'person-centred and shared decision-making model' with 'white collar' background patients.
“Manderbacka55 exploration of decision-making in relation to ‘white collar’ and ‘blue collar’ patients found that doctors were more likely to take a ‘doctor-centred model’ for communication, assessment and decision-making with patients from a ‘blue collar’ background but tended to adopt a ‘person-centred and shared decision-making model’ with ‘white collar’ background patients.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [55] source
May combine two claims.
FindingcitationKrupat et al explored the effect of patient assertiveness in HP decision-making for older adults with breast cancer and similarly discovered that patients with low SES were more likely to have full staging of their cancer investigated when they made assertive requests.
“Krupat et al 51 explored the effect of patient assertiveness in HP decision-making for older adults with breast cancer and similarly discovered that patients with low SES were more likely to have full staging of their cancer investigated when they made assertive requests.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [51] source
May combine two claims.
FindingcitationOlder adults with low income and without medical insurance were less likely to receive a primary cardiac diagnosis, however, this discrimination did not affect younger patients who were low income and without insurance.
“Older adults with low income and without medical insurance were less likely to receive a primary cardiac diagnosis, however, this discrimination did not affect younger patients who were low income and without insurance.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] source
Probably not a substantial claim: may not pass S4 (based).
Findingnone givenThere remains limited understanding about the circumstances in which implicit bias is most likely to appear.
“While there remains limited understanding about the circumstances in which implicit bias is most likely to appear”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
FindingcitationThere appears to be a gap in the evidence that requires further exploration, specifically, there are as yet unanswered questions about how training can successfully raise awareness of SES bias, and how the impact of this training on clinical practice can be assessed or evaluated in the short term and longer term.
“There appears to be a gap in the evidence that requires further exploration, specifically, there are as yet unanswered questions about how training can successfully raise awareness of SES bias, and how the impact of this training on clinical practice can be assessed or evaluated in the short term and longer term.116”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [116] Heffernan M . Wilful blindness. London., Simon and Schuster Uk Ltd; 2019.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S4 (based).
FindingreasoningSome evidence suggests that implicit bias is related to the health professional's cognitive load, as time pressures can diminish self-awareness.
“some evidence suggests that this might be related to the HP’s cognitive load, as time pressures can diminish self-awareness.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
FindingcitationThere is a gap in understanding mechanisms that prevent or inhibit the implicit judgement surfacing as explicit actions, particularly related to HP time and cognitive load.
“There is a gap in understanding mechanisms that prevent or inhibit the implicit judgement surfacing as explicit actions, particularly related to HP time and cognitive load.61 108”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 61 108
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationImplicit biases affect HPs decision-making about different aspects of patient care, such as diagnosis and treatment, often with deleterious consequences for the healthcare of people that are minoritised, marginalised or othered.
“Implicit biases affect HPs decision-making about different aspects of patient care, such as diagnosis and treatment, often with deleterious consequences for the healthcare of people that are minoritised, marginalised or othered.17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Maule, 2002, Heuristics, biases and strategic decision making, Psychologist
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationHPs and patients hold implicit biases alike, which hinder the formation of a therapeutic healthcare relationship, patient experience, clinical decision-making and care quality.
“HPs and patients hold implicit biases alike, which hinder the formation of a therapeutic healthcare relationship, patient experience, clinical decision-making and care quality.9”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe scoping review and its protocol were developed with a member of the public (BA).
“This scoping review (and its previously published protocol) has been developed with a member of the public (BA).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe construct validity of the IAT, as well as its efficacy as a measure of implicit bias, especially as a predictor of real-life behaviour, is contested.
“However, the construct validity of the IAT, as well as its efficacy as a measure of implicit bias, especially as a predictor of real-life behaviour in the context of everyday life is contested.16 21 30 32”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 16 21 30 32
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningDue to the nature of funding, only studies published in English were included, and therefore, this scoping review may have excluded relevant literature published in other languages.
“Due to the nature of funding, only studies published in English were included, and therefore, this scoping review may have excluded relevant literature published in other languages.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe IAT is the most established way of measuring implicit bias and has strong psychometric properties in comparison to other implicit measures.
“The Implicit Association Test (IAT) is the most established way of measuring implicit bias and has strong psychometric properties in comparison to other implicit measures.21 27–30”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 21 27–30
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenStereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load.
“Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load.”
Quote in the paperNot a substantial claim- Rests on an assumption: The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningBA's lived experience and perspective directly shaped the design, results, discussion and implication sections of this work.
“Therefore, BA’s lived experience and perspective have directly shaped the design, results, discussion and implication sections of this work.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenThis scoping review is the first to scope wider literature about the reported impact of HP SES-related bias on clinical decision-making, through a comprehensive and systematic search of all available evidence.
“As far as we are aware, this scoping review is the first to scope wider literature about the reported impact of HP SES-related bias on clinical decision-making, through a comprehensive and systematic search of all the available evidence.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe adapted JBI data extraction form was tested on the first five papers and then adapted as per JBI guidance.
“This access database form was tested on the first five papers and then adapted as per JBI guidance to gather all information pertinent to the review questions.43”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43] Briggs J . Template source of evidence details, characteristics and results extraction instrument; 2020: available at: JBI template source of evidence details, characteristics and results extraction instrument. JBI manual for evidence synthesis. s.l, 2020. Available: https://wiki.jbi.global/display/MANUAL/Appendix+11.1+JBI+template+source+of+evidence+details%2C+characteristics+and+results+extraction+instrument
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataTitles and abstracts of included papers were independently filtered by two members of the project team.
“In the first filter, the titles and abstracts of the included papers were assessed against the inclusion criteria and independently filtered by two members of the project team (CJ and RS).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Study design and conductnone givenThis scoping review has a previously published protocol and has been conducted in line with international standards for best practice, to ensure rigour and transparency.
“This scoping review has a previously published protocol and has been conducted in line with international standards for best practice, to ensure rigour and transparency.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBeyer et al found that education and SES were identified as barriers to HP making equitable treatment decisions.
“Beyer et al 20 explored factors that influence treatment decisions in localised kidney cancer and found that education and SES, were identified as barriers to HP making equitable treatment decisions.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Beyer, 2021, The current evidence for factors that influence treatment decision making in localized kidney cancer: a mixed methods systematic review, J Urol source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningIn keeping with the nature of a scoping review, the quality of literature collected was not evaluated.
“In keeping with the nature of a scoping review, the quality of literature collected was not evaluated.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe stereotype content model (SCM) was first proposed by Fiske and provides a theory that explains how individuals form impressions, assumptions and judgements of other individuals or groups based on their perceived warmth or capability.
“The stereotype content model (SCM) was first proposed by Fiske103 104 and provides a theory that explains how individuals form impressions, assumptions and judgements of other individuals or groups based on their perceived warmth or capability.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 103 104
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningThe words, terminology and language in reference to the people seeking or receiving care seem to be a key influence and, in some cases, a predeterminant of HP attitudes and behaviour that can adversely affect clinical outcomes.
“Therefore, the words, terminology and language in reference to the people seeking or receiving care seem to be a key influence and, in some cases, a predeterminant of HP attitudes and behaviour that can adversely affect clinical outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationStereotypes do not need to be consciously recognised to generate discrimination, they can be subconsciously held and triggered in such a way that people use them to frame their actions and to rationalise what they do, or do not do, in an automatic process with little or no thought or self-awareness.
“Stereotypes do not need to be consciously recognised to generate discrimination, they can be subconsciously held and triggered in such a way that people use them to frame their actions and to rationalise what they do, or do not do, in an automatic process with little or no thought or self-awareness.105”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [105] source
May combine two claims.
InterpretationcitationSES-related discrimination was associated with HP decision-making about who gets cardiac monitoring, which impacted timely cardiac arrest care and patient survival.
“In this instance, SES-related discrimination was associated with HP decision-making about who gets cardiac monitoring, which impacted timely cardiac arrest care and patient survival.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationSES is invariably multifaceted and complex.
“We are aware that the inclusion of papers with single discrete measures such as these may be contested from a social science perspective, as SES is invariably multifaceted and complex.17”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] Maule, 2002, Heuristics, biases and strategic decision making, Psychologist
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningHPs are less patient-centred in these circumstances and the unique features of the patient can be replaced with stereotypical patterns based on the patient belonging to a certain social group/s.
“Therefore, HPs are less patient-centred in these circumstances and the unique features of the patient (which are discovered during comprehensive assessment) can be replaced with stereotypical patterns based on the patient belonging to a certain social group/s.11 107 108”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 11 107 108
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
PremisecitationThe utility of vignette approach in decision-making studies is contingent on the researcher's ability to craft and word a written or visual vignette that reflects the complex nature of reality, and that sets out key information in line with best scientific practice.
“However, the utility of this approach in decision-making studies is contingent on the researcher’s ability to craft and word a written or visual vignette that reflects the complex nature of reality, and that sets out key information in line with best scientific practice.94–96 99”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 94–96 99
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationPatients are less likely to participate in dialogue and shared decision-making if they perceive the HP as judgemental, in this way, HP bias can trigger the patient's bias in a dynamic way, adversely affecting dialogue and patient-centred care.
“Patients are less likely to participate in dialogue and shared decision-making if they perceive the HP as judgemental, in this way, HP bias can trigger the patient’s bias in a dynamic way, adversely affecting dialogue and patient-centred care.51”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [51] source
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
InterpretationreasoningHealth professionals' implicit biases often mirror those of wider society at any given point in time because their values, beliefs, attitude, outlook and world view are tempered and influenced by the communities they belong to and the wider culture they inhabit.
“HPs implicit biases often mirror those of wider society at any given point in time because their values, beliefs, attitude, outlook and world view will be tempered and influenced by the communities that they belong to and the wider culture that they inhabit.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDialogue plays a key role in how we see each other.
“Dialogue plays a key role in how we see each other.111”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [111] Murphy, 2018, The clinical examination and socially at-risk populations, Med Clin N Am source
May combine two claims.
InterpretationreasoningThe evidence collected on intersectionality in this review demonstrates the importance of multivariable reviews of implicit bias, therefore, exploring SES, race, age or gender as individual factors in isolation will not tell the whole story.
“The evidence collected on intersectionality in this review demonstrates the importance of multivariable reviews of implicit bias, therefore, exploring SES, race, age or gender as individual factors in isolation will not tell the whole story.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
InterpretationreasoningBias is dynamic; therefore, the health professional-patient interaction can reinforce perceptions and judgemental attitudes that further embed prejudice or stereotypes.
“Bias is dynamic; therefore, the HP–patient interaction can reinforce perceptions and judgemental attitudes that further embed prejudice or stereotypes.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationThere is empirical evidence which suggests that implicit SES bias can manifest itself in HP-patient behaviours that impede relationship building, which could be mitigated with greater HP self-awareness and greater patient assertiveness.
“Therefore, there is empirical evidence which suggests that implicit SES bias can manifest itself in HP–patient behaviours that impede relationship building, which could be mitigated with greater HP self-awareness and greater patient assertiveness.51 56 111”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 51 56 111
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningImplicit SES-related bias by health professionals adversely affects the care and outcomes of vulnerable people, increasing their risk of suboptimal, inappropriate, or harmful care and harming their well-being, health-related outcomes and life expectancy.
“implicit SES-related bias increases the risk of the most vulnerable people in society experiencing suboptimal, inappropriate, or harmful care.”
- Also stated in: § Implications for practice and policy · plain
“implicit SES-related bias by HPs tends to result in people who are the most vulnerable receiving the worst care, which has a harmful impact on their well-being, health-related outcomes and life expectancy.”
- Also stated in: § Conclusion · hedged
“the bias associated with SES can make vulnerable people more vulnerable and may adversely affect clinical outcomes.”
Quote in the paperSubstantial claim- Also stated in: § Implications for practice and policy · plain
May combine two claims.
PremisecitationIt is not always the case that a person who is inferred as capable is automatically also perceived as warm on the SCM matrix, in fact, some research has shown that when a person is viewed as capable and competent then the perception of warmth is viewed less positively.
“It is not always the case that a person who is inferred as capable is automatically also perceived as warm on the SCM matrix113, in fact, some research has shown that when a person is viewed as capable and competent then the perception of warmth is viewed less positively.102 103 113”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 102 103 113
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationWhen a patient is perceived as lacking capability or competence then their warmth can be viewed more positively as a compensatory effect, which in turn triggers a greater paternalistic behaviour from the HP, that affects their communication style and quality.
“This can mean that when a patient is perceived as lacking capability or competence then their warmth can be viewed more positively as a compensatory effect, which in turn triggers a greater paternalistic behaviour from the HP, that affects their communication style and quality.113”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [113] Durante, 2010, The stereotype content model: the role played by competence in Inferring group status, TPM Test Psychom Methodol Appl Psychol
May combine two claims.
InterpretationcitationPatients with low levels of SES can often be viewed as needing less information because of an assumption they do not wish to be informed because they ask less questions or because they do not have the capacity to retain information, and this assumption actually helps the clinic to regain lost time.
“Patients with low levels of SES can often be viewed as needing less information because of an assumption they do not wish to be informed because they ask less questions or because they do not have the capacity to retain information, and this assumption actually helps the clinic to regain lost time.109”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [109] Kirkham, 2002, Stereotyping as a professional defence mechanism, Br J Midwifery source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThere was no critical appraisal or quality assessment of the included research studies, which is in keeping with JBI scoping review methodology, and was apt; the focus was on mapping the literature on this topic.
“There was no critical appraisal or quality assessment of the included research studies, which is in keeping with JBI scoping review methodology,39 40 and was apt; the focus was on mapping the literature on this topic.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 39 40
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe inclusion of research studies and other types of publications broadened the depth and breadth of this review.
“Conversely, the inclusion of research studies and other types of publications broadened the depth and breadth of this review.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataMost included publications are from North America and Europe in the global north, therefore, the relevance of its results to other parts of the world, especially those that are part of the global south is limited.
“Most included publications are from North America and Europe in the global north, therefore, the relevance of its results to other parts of the world, especially those that are part of what is increasingly referred to as the global south is limited.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSocial status is linked to power, so for people of low SES, there is often a power differential between health professionals and themselves.
“Social status is linked to power so for people of low SES, there is often a power differential between HP’s and themselves.3”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationHeffernan contends that people can find it unpalatable when they are confronted with evidence that challenges their firmly held big ideas, such as HPs who believe that they do no harm and always seek to do good, being informed that their implicit SES-related biases may have deleterious impact on the quality, safety and equity, of patient care.
“Heffernan116 contends that people can find it unpalatable when they are confronted with evidence that challenges their firmly held big ideas, such as HPs who believe that they do no harm and always seek to do good, being informed that their implicit SES-related biases may have deleterious impact on the quality, safety and equity, of patient care.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [116] Heffernan M . Wilful blindness. London., Simon and Schuster Uk Ltd; 2019.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
The search strategy and databases used captured all relevant literature on the topic.
“In our search strategy, we purposively cast a wide net to capture all relevant published papers because of the complexity of defining SES and in total, we screened 11 823 publications across different decades.”
The paper relies on this without support.
The quality of the included studies does not materially affect the review's conclusions.
“In keeping with the nature of a scoping review, the quality of literature collected was not evaluated.”
The paper relies on this without support.
The included studies' reported associations between SES and HP decision-making reflect real-world clinical decision-making.
“Meaning that in over two-thirds of the research papers reviewed HP decision-making about assessment, investigations, treatment or care was influenced by a person’s SES.”
The paper relies on this without support.
The PAGER framework is appropriate for analysing and reporting the data.
“Data analysis, interpretation and reporting was underpinned by the PAGER framework.46”
The paper relies on this without support.
The included studies' findings on SES-related disparities in decision-making reflect HP implicit bias.
“This pioneering scoping review has generated key insights into what has been published about HP implicit SES bias, and how it affects HPs attitudes or behaviours as they make decisions about the provision of care for patients.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Occupational therapist no-link percentage is incorrect
MinorThe sole occupational therapist study found no link, so the no-link percentage is 100%, not 0%.
Reported 0 · recomputed 100
“| Occupational therapist | n=0 | 0 | n=1 | 0 | n=1 |”
Coronary heart disease link percentage is incorrect
MinorSeven of eight studies is 87.5%, not 86%. The text elsewhere correctly reports 87.5% for these studies.
Reported 86 · recomputed 87.5
“| Coronary heart disease | n=7 | 86 | n=1 | 14 | n=8 |”
Multiple-conditions no-link percentage is incorrect
MinorSix of nine studies is 66.7%, not 62%.
Reported 62 · recomputed 66.666667
“| Multiple conditions | n=3 | 38 | n=6 | 62 | n=9 |”
Coronary heart disease no-link percentage is incorrect
MinorOne of eight studies is 12.5%, not 14%.
Reported 14 · recomputed 12.5
“| Coronary heart disease | n=7 | 86 | n=1 | 14 | n=8 |”
Multiple-conditions link percentage is incorrect
MinorThree of nine studies is 33.3%, not 38%.
Reported 38 · recomputed 33.333333
“| Multiple conditions | n=3 | 38 | n=6 | 62 | n=9 |”
Cites
The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n71 · Cited by 108,283 · see citing works
PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0850 · Cited by 43,565 · see citing works
Guidance for conducting systematic scoping reviews
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“We conducted a scoping review using Joanna Briggs Institute (JBI) methodology 39 40 as set out in our a priori published protocol 13 and reported our results in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols and Scoping Reviews (PRISMA-ScR) guidelines.”
BackgroundMethodPhelan, J. C., Link, B. G., & Tehranifar, P. (2010) · Journal of Health and Social Behavior · doi:10.1177/0022146510383498 · Cited by 2,533 · cited 1× · see citing works
“The results of this scoping review highlighted various aspects of what has been published about implicit SES bias and HP attitudes or behaviours when deciding and providing care.”
BackgroundImplicit bias in healthcare professionals: a systematic review
FitzGerald, C., & Hurst, S. (2017) · BMC Medical Ethics · doi:10.1186/s12910-017-0179-8 · Cited by 2,398 · cited 5× · see citing works
“16 31 33 One view is that there is specious evidence of the predictive validity of the IAT with regard to implicit racial bias.”
BackgroundInfluentialInvestigating Neighborhood and Area Effects on Health
Roux, A. V. D. (2001) · American Journal of Public Health · doi:10.2105/ajph.91.11.1783 · Cited by 1,841 · see citing works
The effect of patient race and socio-economic status on physicians' perceptions of patients
van Ryn, M., & Burke, J. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(99)00338-x · Cited by 1,509 · cited 1× · see citing works
“8 9 12 Therefore, it is imperative to under-take a scoping review that maps all pertinent evidence, integrates contemporary knowledge about this topic, clarifies key concepts, sets out evidence-based recommendations for practice and identifies the priorities for future research.”
BackgroundHow to properly use the PRISMA Statement
Sarkis-Onofre, R., Catalá-López, F., Aromataris, E., & Lockwood, C. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01671-z · Cited by 1,104 · cited 1× · see citing works
“41 42 A detailed account of methods used in this scoping review is provided in our a priori published protocol 13 , which has granular details about key elements such as the search strategy, inclusion/ exclusion criteria which can be replicated.”
MethodStereotype Content: Warmth and Competence Endure
Fiske, S. T. (2018) · Current Directions in Psychological Science · doi:10.1177/0963721417738825 · Cited by 839 · see citing works
Multidimensional Deprivation: Contrasting Social Welfare and Counting Approaches
Atkinson, A. B. (2003) · The Journal of Economic Inequality · doi:10.1023/a:1023903525276 · Cited by 797 · see citing works
Maina, I., Belton, T. D., Ginzberg, S. P., Singh, A., & Johnson, T. J. (2017) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2017.05.009 · Cited by 716 · cited 5× · see citing works
“21 The Implicit Association Test (IAT) is the most established way of measuring implicit bias and has strong psychometric properties in comparison to other implicit measures.”
BackgroundInfluentialEvans, S. C., Roberts, M. C., Keeley, J. W., Blossom, J. B., Amaro, C. M., Garcia, A. M., Stough, C. C. O., Canter, K. S., Robles, R., & Reed, G. M. (2015) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2014.12.001 · Cited by 683 · cited 1× · see citing works
“17 A comprehensive discussion about the utility or otherwise of different discrete or proxy measures is beyond the remit of this paper, but there are some constraints to the use of some discrete measures such as income as a proxy for SES.”
BackgroundSocio-economic status of the patient and doctor–patient communication: does it make a difference?
Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., & De Maeseneer, J. (2005) · Patient Education and Counseling · doi:10.1016/j.pec.2004.02.011 · Cited by 582 · cited 3× · see citing works
“Willems et al 12 found that patients with lower SES had a less positive dialogue with their doctor, characterised by lower levels of information giving, less interactive discourse and a lower level of doctor advice/instruction.”
BackgroundDo Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record
P. Goddu, A., O’Conor, K. J., Lanzkron, S., Saheed, M. O., Saha, S., Peek, M. E., Haywood, C., & Beach, M. C. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4289-2 · Cited by 437 · cited 1× · see citing works
“25 27–29 44 53 59 61 67 74 80 88 89 There were no discernible patterns or trends in the characteristics of these 13 papers, which used a variety of methodologies, involved different HPs across a range of specialty settings.”
BackgroundHow Socioeconomic Status Affects Patient Perceptions of Health Care: A Qualitative Study.
Arpey, N. C., Gaglioti, A. H., & Rosenbaum, M. E. (2017) · Journal of Primary Care & Community Health · doi:10.1177/2150131917697439 · Cited by 413 · see citing works
A systematic review of the impact of physician implicit racial bias on clinical decision making
Dehon, E., Weiss, N., Jones, J., Faulconer, W., Hinton, E., & Sterling, S. (2017) · Academic Emergency Medicine · doi:10.1111/acem.13214 · Cited by 404 · cited 2× · see citing works
“30 31 A consensus exists among researchers with regard to the IAT’s lack of a high test–retest reliability in the same individual.”
BackgroundScoping reviews: the PAGER framework for improving the quality of reporting
Bradbury-Jones, C., Aveyard, H., Herber, O. R., Isham, L., Taylor, J., & O’Malley, L. (2022) · International Journal of Social Research Methodology · doi:10.1080/13645579.2021.1899596 · Cited by 377 · cited 1× · see citing works
“In our search strategy, we purposively cast a wide net to capture all relevant published papers because of the complexity of defining SES and in total, we screened 11 823 publications across different decades.”
MethodGopaldas, A. (2013) · Journal of Public Policy & Marketing · doi:10.1509/jppm.12.044 · Cited by 375 · see citing works
Dovidio, J. F., & Fiske, S. T. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300601 · Cited by 352 · cited 3× · see citing works
“The intersectional interaction between different factors is arguably a reflection of the continuous nature of perceived warmth and capability matrix as previously described in the SCM, but the outcome for the patient can be bleaker when racial and class biases stereotypes overlap.”
BackgroundInfluentialImplicit bias in healthcare: clinical practice, research and decision making
Gopal, D. P., Chetty, U., O'Donnell, P., Gajria, C., & Blackadder-Weinstein, J. (2021) · Future Healthcare Journal · doi:10.7861/fhj.2020-0233 · Cited by 298 · cited 1× · see citing works
“Most included publications are from North America and Europe in the global north, therefore, the relevance of its results to other parts of the world, especially those that are part of what is increasingly referred to as the global south is limited.”
BackgroundStrong claims and weak evidence: Reassessing the predictive validity of the IAT.
Blanton, H., Jaccard, J. J., Klick, J., Mellers, B. A., Mitchell, G., & Tetlock, P. E. (2009) · Journal of Applied Psychology · doi:10.1037/a0014665 · Cited by 295 · cited 1× · see citing works
“30 34 This characterisation of the IAT’s utility in establishing implicit racial bias is strongly disputed by many others, 30 35 36 who have a different understanding and conclusions predicated on the same data set.”
BackgroundHaider, A. H., Sexton, J., Sriram, N., Cooper, L. A., Efron, D. T., Swoboda, S., Villegas, C. V., Haut, E. R., Bonds, M., Pronovost, P. J., et al. (2011) · JAMA · doi:10.1001/jama.2011.1248 · Cited by 274 · cited 3× · see citing works
“In addition, this scoping review has also revealed how SES can affect the interpersonal dynamics of the HP and patient/service user in their relationship during care delivery.”
BackgroundResultHow social-class stereotypes maintain inequality
Durante, F., & Fiske, S. T. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.07.033 · Cited by 230 · cited 3× · see citing works
“8 9 11 24 26 Consequently, there is a more deliberate, volitive and intentional process to decision-making when explicit bias is at play in contrast to the tacit, covert, unintentional nature of the relationship between implicit bias and decision-making.”
BackgroundNon-medical influences on medical decision-making
McKinlay, J. B., Potter, D. A., & Feldman, H. A. (1996) · Social Science & Medicine · doi:10.1016/0277-9536(95)00342-8 · Cited by 220 · cited 2× · see citing works
“51 Manderbacka 55 exploration of decision-making in relation to ‘white collar’ and ‘blue collar’ patients found that doctors were more likely to take a ‘doctor-centred model’ for communication, assessment and decision-making with patients from a ‘blue collar’ background but tended to adopt a…”
BackgroundImplicit Race Attitudes Predicted Vote in the 2008 U.S. Presidential Election
Greenwald, A. G., Smith, C. T., Sriram, N., Bar‐Anan, Y., & Nosek, B. A. (2009) · Analyses of Social Issues and Public Policy · doi:10.1111/j.1530-2415.2009.01195.x · Cited by 220 · cited 2× · see citing works
“16 30 Conversely, others 30 32 maintain that implicit and explicit measures of bias are not superfluous but have their merits in informing predictions about human behaviour in different ways that are distinct from each other.”
BackgroundIntergroup biases: a focus on stereotype content
Fiske, S. T. (2015) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2015.01.010 · Cited by 215 · cited 3× · see citing works
“…representative (BA), a librarian/ information technologist (AC) and three HP academics (CJ, PG and RS), we reached a consensus on how best to convey the results to others in plain English, a series of recommendations for implementation in practice, as well as the priorities for future research.”
BackgroundBurgess, D. J. (2010) · Medical Decision Making · doi:10.1177/0272989x09341751 · Cited by 213 · see citing works
Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Bernheim, S. M., Ross, J. S., Krumholz, H. M., & Bradley, E. H. (2008) · The Annals of Family Medicine · doi:10.1370/afm.749 · Cited by 212 · see citing works
Haider, A. H., Schneider, E. B., Sriram, N., Dossick, D. S., Scott, V. K., Swoboda, S. M., Losonczy, L. I., Haut, E. R., Efron, D. T., Pronovost, P. J., et al. (2015) · JAMA Surgery · doi:10.1001/jamasurg.2014.4038 · Cited by 205 · see citing works
Arber, S., McKinlay, J., Adams, A., Marceau, L., Link, C., & O’Donnell, A. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.05.028 · Cited by 184 · see citing works
Understanding and Using the Brief Implicit Association Test: Recommended Scoring Procedures
Nosek, B. A., Bar-Anan, Y., Sriram, N., Axt, J., & Greenwald, A. G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0110938 · Cited by 179 · cited 4× · see citing works
“21 27–30 Therefore, it is important to briefly consider its strengths and limitations.”
BackgroundInfluentialBlodgett, A. T., Schinke, R. J., Smith, B. M., Peltier, D., & Pheasant, C. (2011) · Qualitative Inquiry · doi:10.1177/1077800411409885 · Cited by 176 · see citing works
Eckerd, S., DuHadway, S., Bendoly, E., Carter, C. R., & Kaufmann, L. (2020) · Journal of Operations Management · doi:10.1002/joom.1128 · Cited by 172 · see citing works
The human gut microbiome and health inequities
Amato, K. R., Arrieta, M., Azad, M. B., Bailey, M. T., Broussard, J. L., Bruggeling, C. E., Claud, E. C., Costello, E. K., Davenport, E., Dutilh, B. E., et al. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2017947118 · Cited by 167 · cited 1× · see citing works
“113 Castaneda ‐ Guarderas et al 114 and Krupat et al 51 assert that the perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.”
BackgroundHaider, A. H., Schneider, E. B., Sriram, N., Dossick, D. S., Scott, V. K., Swoboda, S. M., Losonczy, L., Haut, E. R., Efron, D. T., Pronovost, P. J., et al. (2014) · Journal of Trauma and Acute Care Surgery · doi:10.1097/ta.0000000000000392 · Cited by 147 · see citing works
Tamayo-Sarver, J. H., Dawson, N. V., Hinze, S. W., Cydulka, R. K., Wigton, R. S., Albert, J. M., Ibrahim, S. A., & Baker, D. W. (2003) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2003.tb00608.x · Cited by 126 · see citing works
Decision making biases in the allied health professions: A systematic scoping review
Featherston, R., Downie, L. E., Vogel, A. P., & Galvin, K. L. (2020) · PLoS ONE · doi:10.1371/journal.pone.0240716 · Cited by 125 · cited 1× · see citing works
“Several scoping reviews 24 33 38 have highlighted the valuable insights into implicit bias and its impact on HPs decision-making that can be gained from studies that use other research methods such as case study vignettes, questionnaires, think-aloud interviews, randomised controlled trials and…”
MethodCognitive and implicit biases in nurses' judgment and decision-making: A scoping review
Thirsk, L. M., Panchuk, J. T., Stahlke, S., & Hagtvedt, R. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104284 · Cited by 120 · see citing works
Vignette-Based Utilities: Usefulness, Limitations, and Methodological Recommendations
Matza, L. S., Stewart, K. D., Lloyd, A. J., Rowen, D., & Brazier, J. E. (2021) · Value in Health · doi:10.1016/j.jval.2020.12.017 · Cited by 119 · see citing works
Kunesh, C. E., & Noltemeyer, A. (2019) · Urban Education · doi:10.1177/0042085915623337 · Cited by 113 · see citing works
Haider, A. H., Schneider, E. B., Sriram, N., Scott, V. K., Swoboda, S. M., Zogg, C. K., Dhiman, N., Haut, E. R., Efron, D. T., Pronovost, P. J., et al. (2015) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2015.01.065 · Cited by 112 · see citing works
The Unexpected Influence of Physician Attributes on Clinical Decisions: Results of an Experiment
McKinlay, J. B., Lin, T. H., Freund, K. M., & Moskowitz, M. A. (2002) · Journal of Health and Social Behavior · doi:10.2307/3090247 · Cited by 111 · see citing works
Patient assertiveness and physician decision-making among older breast cancer patients
Krupat, E., Irish, J. T., Kasten, L. E., Freund, K. M., Burns, R. B., Moskowitz, M. A., & McKinlay, J. B. (1999) · Social Science & Medicine · doi:10.1016/s0277-9536(99)00106-9 · Cited by 101 · cited 7× · see citing works
“…other words, everyone has a rationale or vocabulary of motive, for what they do or do not do, which means that it is challenging for anyone to accept that they have implicit biases, Open access which are often contrary to the way a person thinks about themselves and their behaviour towards others.”
BackgroundInfluentialHastert, T. A., Ruterbusch, J. J., Beresford, S. A. A., Sheppard, L. A., & White, E. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.11.023 · Cited by 97 · see citing works
Model minority stereotype: influence on perceived mental health needs of Asian Americans
Cheng, A. W., Chang, J., O’Brien, J., Budgazad, M. S., & Tsai, J. (2017) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-016-0440-0 · Cited by 84 · cited 1× · see citing works
“56 A formal SES or deprivation measure was used in only three of the studies included in this review.”
MethodFeldman, H. A., McKinlay, J. B., Potter, D. A., Freund, K. M., Burns, R. B., Moskowitz, M. A., & Kasten, L. E. (1997) · Europe PMC (PubMed Central) · Cited by 82 · see citing works
Sheringham, J., Kuhn, I., & Burt, J. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01247-4 · Cited by 82 · see citing works
Hirsh, A. T., Miller, M. M., Hollingshead, N. A., Anastas, T., Carnell, S., Lok, B. C. L., Chu, C., Zhang, Y., Robinson, M. E., Kroenke, K., et al. (2019) · Pain · doi:10.1097/j.pain.0000000000001634 · Cited by 73 · see citing works
Unconscious Bias among Health Professionals: A Scoping Review
Meidert, U., Dönnges, G., Bücher, T., Wieber, F., & Gerber‐Grote, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20166569 · Cited by 72 · cited 2× · see citing works
“11 16 21–23 Explicit bias occurs when the individual has conscious thoughts, beliefs and awareness that they evaluate people differently based on their characteristics, these evaluations consciously influence their behaviours and decision-making.”
BackgroundMcKinlay, J. B., Burns, R. B., Durante, R., Feldman, H. A., Freund, K. M., Harrow, B. S., Irish, J. T., Kasten, L. E., & Moskowitz, M. A. (1997) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.1997.tb00067.x · Cited by 67 · cited 1× · see citing works
“13 19 In other words, we assert that healthcare professionals are more likely to use discrete measures of SES, rather than more robust empirical measures to inform their perceptions of patients in everyday practice.”
BackgroundMartin, G. P., Aveling, E., Campbell, A., Tarrant, C., Pronovost, P. J., Mitchell, I., Dankers, C. A., Bates, D. W., & Dixon‐Woods, M. (2018) · BMJ Quality & Safety · doi:10.1136/bmjqs-2017-007579 · Cited by 67 · see citing works
Oncologists’ recommendations of clinical trial participation to patients
Eggly, S. S., Albrecht, T. L., Harper, F. W. K., Foster, T. S., Franks, M. M., & Ruckdeschel, J. C. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.09.019 · Cited by 64 · see citing works
Shared decision making with vulnerable populations in the emergency department
Castaneda‐Guarderas, A., Glassberg, J., Grudzen, C. R., Ngai, K. M., Samuels‐Kalow, M. E., Shelton, E., Wall, S. P., & Richardson, L. D. (2016) · Academic Emergency Medicine · doi:10.1111/acem.13134 · Cited by 63 · cited 1× · see citing works
“…representative (BA), a librarian/ information technologist (AC) and three HP academics (CJ, PG and RS), we reached a consensus on how best to convey the results to others in plain English, a series of recommendations for implementation in practice, as well as the priorities for future research.”
BackgroundDiniz, E., Castro, P., Bousfield, A. B. D. S., & Bernardes, S. F. (2019) · British Journal of Health Psychology · doi:10.1111/bjhp.12399 · Cited by 63 · cited 2× · see citing works
“However, half of the studies (50%; n=24) 19 used the IAT to gather data regarding the participants’ favourable bias as a precursor to vignette examination of decision-making.”
BackgroundHeuristics, biases and strategic decision making
Maule, A. J., & Hodgkinson, G. P. (2026) · Research Explorer (The University of Manchester) · doi:10.82444/warw.33712303 · Cited by 60 · see citing works
Thompson, J. P., Bujalka, H., McKeever, S., Lipscomb, A., Moore, S., Hill, N., Kinney, S., Cham, K. M., Martín, J. M. M., Bowers, P. J., et al. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04371-5 · Cited by 59 · cited 1× · see citing works
“Several scoping reviews 24 33 38 have highlighted the valuable insights into implicit bias and its impact on HPs decision-making that can be gained from studies that use other research methods such as case study vignettes, questionnaires, think-aloud interviews, randomised controlled trials and…”
MethodPredicting human behavior toward members of different social groups
Jenkins, A. C., Karashchuk, P., Zhu, L., & Hsu, M. (2018) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1719452115 · Cited by 58 · see citing works
“We’re a Little Biased”: Medicine and the Management of Bias through the Case of Contraception
Manzer, J. L., & Bell, A. V. (2021) · Journal of Health and Social Behavior · doi:10.1177/00221465211003232 · Cited by 58 · cited 1× · see citing works
“16 Denberg et al 57”
Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality
Popescu, I., Schrag, D., Ang, A., et al. (2016) · Medical Care · doi:10.1097/mlr.0000000000000561 · Cited by 57 · see citing works
Anastas, T. M., Miller, M. M., Hollingshead, N. A., Stewart, J. C., Rand, K. L., & Hirsh, A. T. (2020) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaa016 · Cited by 56 · cited 2× · see citing works
“16 110 Our results show that intersec-tionality can have a powerful cumulative effect on HP assessment and subsequent decision-making.”
BackgroundMills, T. F. P., Patel, N., & Ryan, K. (2020) · International Journal of Clinical Practice · doi:10.1111/ijcp.13827 · Cited by 49 · see citing works
Bodies of risk: constructing motherhood in a mexican public hospital
Smith-Oka, V. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.08.029 · Cited by 47 · cited 1× · see citing works
“16 Denberg et al 57”
Decisions to Treat Critically Ill Patients: A Comparison of Social versus Medical Considerations
Crane, D. (1975) · The Milbank Memorial Fund Quarterly Health and Society · doi:10.2307/3349616 · Cited by 42 · cited 1× · see citing works
“This progresses into a tightly focused discussion of our results aligned to each research question in relation to the wider literature.”
ResultHajjaj, F. M., Salek, S., Basra, M. K. A., & Finlay, A. Y. (2010) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2010.09868.x · Cited by 39 · cited 1× · see citing works
“This progresses into a tightly focused discussion of our results aligned to each research question in relation to the wider literature.”
ResultAgerström, J., Carlsson, M., Bremer, A., Herlitz, J., Israelsson, J., & Årestedt, K. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa954 · Cited by 38 · cited 1× · see citing works
“16 Denberg et al 57”
Nampiaparampil, D. E., Nampiaparampil, J. X., & Harden, R. N. (2009) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00612.x · Cited by 37 · see citing works
Factors influencing pharmacists’ clinical decision making in pharmacy practice
Mertens, J. F., Koster, E. S., Deneer, V. H. M., Bouvy, M. L., & van Gelder, T. (2023) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2023.05.009 · Cited by 34 · see citing works
Jala, S., Fry, M., & Elliott, R. M. (2023) · Journal of Clinical Nursing · doi:10.1111/jocn.16845 · Cited by 34 · cited 2× · see citing works
“Several scoping reviews 24 33 38 have highlighted the valuable insights into implicit bias and its impact on HPs decision-making that can be gained from studies that use other research methods such as case study vignettes, questionnaires, think-aloud interviews, randomised controlled trials and…”
BackgroundMethodDenberg, T. D., Kim, F. J., Flanigan, R. C., Fairclough, D., Beaty, B. L., Steiner, J. F., & Hoffman, R. M. (2006) · Medical Care · doi:10.1097/01.mlr.0000233684.27657.36 · Cited by 33 · see citing works
Williams, R. L., Romney, C., Kano, M. A., Wright, R., SKIPPER, B. J., Getrich, C. M., Sussman, A. L., & Zyzanski, S. J. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-014-3168-3 · Cited by 33 · see citing works
A systematic review of implicit bias in health care: A call for intersectionality
Ogungbe, O., Mitra, A., & Roberts, J. (2019) · IMC Journal of Medical Science · doi:10.3329/imcjms.v13i1.42050 · Cited by 33 · cited 1× · see citing works
“There is also evidence from a systematic review 37 , which highlights the limitations of the IAT in establishing multiplicative effect of several biases that intersect across multiple social identities.”
BackgroundWeak criticisms and selective evidence: Reply to Blanton et al. (2009).
McConnell, A. R., & Leibold, J. M. (2009) · Journal of Applied Psychology · doi:10.1037/a0014649 · Cited by 31 · cited 1× · see citing works
“30 34 This characterisation of the IAT’s utility in establishing implicit racial bias is strongly disputed by many others, 30 35 36 who have a different understanding and conclusions predicated on the same data set.”
BackgroundPatient-nephrologist discussions about kidney transplantation as a treatment option.
Gordon, E. J., & Sehgal, A. (2000) · Advances in Renal Replacement Therapy · doi:10.1053/rr.2000.5268 · Cited by 30 · cited 1× · see citing works
“This progresses into a tightly focused discussion of our results aligned to each research question in relation to the wider literature.”
ResultPutting cognitive psychology to work: Improving decision-making in the medical encounter
Schwab, A. P. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.09.005 · Cited by 28 · cited 1× · see citing works
“7 The causes of the social gradient in health are complex, and the exact nature of the relationship is difficult to establish because it is informed by both individual factors such as health behaviour and also factors associated with economic wealth.”
BackgroundAbuzour, A. S., Lewis, P. J., & Tully, M. P. (2017) · Journal of Advanced Nursing · doi:10.1111/jan.13375 · Cited by 28 · see citing works
Developing Video vignettes for tourism research: protocol and quality indicators
Chen, N., Hsu, C. H. C., & L. Pearce, P. (2022) · Journal of Travel Research · doi:10.1177/00472875211051413 · Cited by 27 · see citing works
“We’re a Little Biased”: Medicine and the Management of Bias Through the Case of Contraception
Manzer, J. L., & Bell, A. V. (2021) · Journal of Health and Social Behavior · doi:10.1177/00221465211008328 · Cited by 26 · see citing works
Gonzales, F. A., Sangaramoorthy, M., Dwyer, L. A., Shariff‐Marco, S., Allen, A. M., Kurian, A. W., Yang, J., Langer, M. M., Allen, L., Reeve, B. B., et al. (2019) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00820-7 · Cited by 25 · see citing works
Gilbert, A., Benjamin, A., & Abenhaim, H. A. (2010) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/s1701-2163(16)34681-3 · Cited by 23 · see citing works
The rise of non-medical prescribing and medical dominance
Weiss, M. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.05.015 · Cited by 23 · see citing works
Interprofessional collaboration-time for a new theory of action?
Samuriwo, R. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.876715 · Cited by 23 · see citing works
Self-citationSpontaneous activity competes with externally evoked responses in sensory cortex
Karvat, G., Alyahyay, M., & Diester, I. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2023286118 · Cited by 23 · see citing works
Feldmann, J., Puhan, M. A., & Mütsch, M. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024587 · Cited by 22 · see citing works
Stereotyping as a professional defence mechanism
Kirkham, M., Stapleton, H., Curtis, P., & Thomas, G. (2002) · British Journal of Midwifery · doi:10.12968/bjom.2002.10.9.10609 · Cited by 21 · see citing works
Perceptions of women's infertility: what do physicians see?
Ceballo, R., Abbey, A., & Schooler, D. E. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.11.019 · Cited by 20 · see citing works
Job, C., Adenipekun, B., Cleves, A., & Samuriwo, R. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059837 · Cited by 20 · cited 4× · see citing works
“13 21 Explicit bias relates to 'ways of thinking' that people are aware of and so can be measured through self-report, but there is the risk of people providing socially desirable responses.”
BackgroundMethodInfluentialSelf-citationBeyer, K., Barod, R., Fox, L., Van Hemelrijck, M., & Kinsella, N. (2021) · Journal of Urology · doi:10.1097/ju.0000000000001901 · Cited by 19 · cited 1× · see citing works
“Beyer et al 20 explored factors that influence treatment decisions in localised kidney cancer and found that education and SES, were identified as barriers to HP making equitable treatment decisions.”
BackgroundMcKinlay, J., Piccolo, R., & Marceau, L. (2013) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12015 · Cited by 18 · see citing works
Bernardes, S. F., Tomé-Pires, C., Brandão, T., Campos, L., Teixeira, F., & Goubert, L. (2021) · Pain · doi:10.1097/j.pain.0000000000002278 · Cited by 18 · see citing works
Can Non-medical Factors Contribute to Disparities in Coronary Heart Disease Treatments?
Barnhart, J. M., Cohen, O., Wright, N., & Wylie-Rosett, J. (2006) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2006.0097 · Cited by 17 · cited 1× · see citing works
“…representative (BA), a librarian/ information technologist (AC) and three HP academics (CJ, PG and RS), we reached a consensus on how best to convey the results to others in plain English, a series of recommendations for implementation in practice, as well as the priorities for future research.”
BackgroundExploring gender and socioeconomic differences in treatment of coronary heart disease
Manderbacka, K. (2005) · European Journal of Public Health · doi:10.1093/eurpub/cki050 · Cited by 17 · see citing works
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“However, half of the studies (50%; n=24) 19 used the IAT to gather data regarding the participants’ favourable bias as a precursor to vignette examination of decision-making.”
BackgroundStrong rebuttal for weak criticisms: Reply to Blanton et al. (2009).
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“30 34 This characterisation of the IAT’s utility in establishing implicit racial bias is strongly disputed by many others, 30 35 36 who have a different understanding and conclusions predicated on the same data set.”
BackgroundPettit, K., Turner, J. S., Kindrat, J. K., Blythe, G. J., Hasty, G., Perkins, A. J., Ashburn‐Nardo, L., Milgrom, L. B., Hobgood, C., & Cooper, D. (2017) · AEM Education and Training · doi:10.1002/aet2.10022 · Cited by 16 · see citing works
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“87 Meaning that in over two-thirds of the research papers reviewed HP decision-making about assessment, investigations, treatment or care was influenced by a person’s SES.”
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“This scoping review has its limitations which must be given consideration.”
BackgroundCan we tell whether hospital care is safe?
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Exploring the world “out there”: the use of scoping reviews in education research
Godfrey, C. M. (2020) · JBI Evidence Synthesis · doi:10.11124/jbies-20-00134 · Cited by 6 · cited 2× · see citing works
“We conducted a scoping review using Joanna Briggs Institute (JBI) methodology 39 40 as set out in our a priori published protocol 13 and reported our results in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols and Scoping Reviews (PRISMA-ScR) guidelines.”
BackgroundMethodVlietstra, T., Woodger, N., Northeast, T., McNamara, A. J., & Morison, L. A. (2020) · Counselling and Psychotherapy Research · doi:10.1002/capr.12318 · Cited by 5 · see citing works
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“8 9 The gradient in health and SES is also subject to a person’s power, prestige and the social connections”
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“Thirteen papers did not detect any SES-related bias in HP decision-making.”
BackgroundUnconscious Bias and the Impacts on Caring: The Role of the Clinical Nursing Instructor
Crandlemire, L. A. (2020) · International journal for human caring · doi:10.20467/humancaring-d-19-00048 · Cited by 4 · see citing works
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“However, half of the studies (50%; n=24) 19 used the IAT to gather data regarding the participants’ favourable bias as a precursor to vignette examination of decision-making.”
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Community Health Centers Primary Care Physicians' Asthma Management Perception of Uninsured Patients
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Flagged first, then by citations
2 of the 118 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Continuous glucose sensor accuracy: beyond the headline metric
Oliver, N. S., Reddy, M., & Leelarathna, L. (2024) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(24)00245-6 · Cited by 20 · see citing works
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“For example, healthcare professionals’ biases towards and stereotyping of people from lower socioeconomic backgrounds have been found to adversely affect clinical decision making for disadvantaged patients (Job et al., 2024).”
McHenry, R. D., Moultrie, C. E., Corfield, A. R., Lone, N., Mackay, D., & Pell, J. P. (2025) · Journal of the Intensive Care Society · doi:10.1177/17511437251338608 · Cited by 9 · see citing works
“29 The most deprived groups had shorter length of stay, but higher mortality, even for those patients discharged alive.”
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“Research illustrates that low wages often result in issues such as food insecurity [12,13], limited access to healthcare [14], and lower quality of health care [15].”
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“In addition, a scoping review from 2024 on implicit bias and clinical decision-making by health professionals reported that 73% of the primary research studies included in the review found an association between health care bias and SES [10].”
A mixed methods systematic review of cancer treatment decision-making in vulnerable populations
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İnan, M., & Aypak, C. (2026) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2026.104929 · Cited by 1 · see citing works
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Sources of Variation in Cardiovascular Care Cascades
Wang, A. Z., Shanmugam, D., Divakaran, S., Pierson, E., & Barnett, M. L. (2026) · JAMA Health Forum · doi:10.1001/jamahealthforum.2026.0491 · Cited by 1 · see citing works
Groenewegen, P., Keskimäki, I., & Leyland, A. H. (2026) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2026-226527 · Cited by 1 · see citing works
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Richards, K., Reed, K., & Parrish, A. (2025) · Australian Occupational Therapy Journal · doi:10.1111/1440-1630.70019 · Cited by 1 · see citing works
“Job et al. (2024) echoed similar challenges in their scoping review where implicit biases, particularly those linked to socio-economic status, persist in clinical decision-making and contribute to health disparities, particularly under stress or cognitive load — common features of contemporary…”
Wilson, L. F., Dobson, A. J., Wallis, K. A., Doust, J. A., & Mishra, G. D. (2025) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674251362038 · Cited by 1 · see citing works
“It is also possible people of low socioeconomic status may receive differential treatment based on implicit bias and stereotyping by medical practitioners (especially if the consultation is short) (Job et al., 2024).”
Nurses’ attitudes and perceptions towards homelessness
Burton, R., & Shepherd, A. (2025) · Journal of Nursing Education and Practice · doi:10.63564/jnep.v15n6p17
“[23] 1.4 Researchers’ hypothesis states that the Attitudes Towards Homelessness Inventory (ATHI) will reveal negative attitudes and potential biases towards homelessness from the nursing participants.”
InfluentialCheetham, N. J., Beattie, A., Comery, A., Bowyer, V., Carpentieri, J., & Steves, C. J. (2026) · Health Expectations · doi:10.1111/hex.70692
Garza, H. H., Comer-HaGans, D., Bradford, J. M., Brown, C. V. R., Naiditch, J. A., & Lawson, K. A. (2025) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000004711
Dress the way you want to be addressed:” Factors Contributing to Differential Care during ChildbirthPreprint
Kuwolamo, I., Aborigo, R., Dorzie, J. B. K., Ansah, P. B., Moro, A., Nutor, J. J., & Afulani, P. A. (2025) · Research Square · doi:10.21203/rs.3.rs-7243708/v1
Health Service Provision and Differential Service Utilization, Treatment, and Benefits
Groenewegen, P., Keskimäki, I., & Leyland, A. H. (2025) · SpringerBriefs in public health · doi:10.1007/978-3-032-02565-4_6
The social determinants of health within Belgian pharmacies: an exploratory qualitative studyPreprint
de Beeck, E. O., & Loof, H. D. (2025) · Research Square · doi:10.21203/rs.3.rs-7767744/v1
Bias, Poverty, and Caring: Preparing Nurses for Equitable Practice
Shilling, A. (2025) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000932
Poquet, D., de Lauzon‐Guillain, B., Ley, D., et al. (2026) · International Breastfeeding Journal · doi:10.1186/s13006-026-00812-1
“Such training should aim to reduce negative stereotypes and implicit bias that could undermine the quality of care and reinforce treatment inequalities [41, 48–50].”
Estifanos, A. S., Addis, M., Getachew, H., Ireso, B. R., Dimtse, A., Metaferia, G., Woldehawariat, T. D., Walelegn, M., Magge, H., Roro, M. A., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2024-093030
“22 On the other hand, parents’ utilisation of healthcare services and their interactions with healthcare professionals are shaped by their cultural beliefs and practices.”
Demanse, D., Saxer, F., Gazit, S., Patalon, T., & Schieker, M. (2026) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-026-03435-y
“Aspects such as unconscious bias from health care providers towards patients of low socio-economic status [60], but also behavioral factors associated with low socio-economic status e.g. health literacy and often associated lifestyle preferences could play a role [61–64].”
Khan, S. A., Khan, M. A., Lynch, I., Khan, N., Khan, S. E., Zafar, F., Ventura-Gabarró, C., Westwood, E., Kalbarczyk, A., Morgan, R., et al. (2026) · Health Policy and Planning · doi:10.1093/heapol/czag029
Haichin, K., Alter, D. A., Poirier, P., Ni, J., Tardif, J., Goodman, S. G., Yan, A. T.-K., Ko, D. T., d’Entremont, M.-A., Lawler, P. R., et al. (2026) · CJC Open · doi:10.1016/j.cjco.2026.03.014
“22 Low annual household income had differential effects on female and male CARTaGENE participants, with increased ASCVD risk observed primarily among male participants.”
Yu, Z., Shen, F., & Mi, R. Z. (2026) · Journal of Health Communication · doi:10.1080/10810730.2026.2657838
“Such dynamics undermine trust and contribute to delayed care—patterns associated with higher emergency department use, lower uptake of preventive services, and poorer outcomes (Bellis et al., 2024; Henderson et al., 2022; Job et al., 2024).”
Eid, T., Alyahya, N. M., Alodhialah, A. M., et al. (2026) · Current Oncology · doi:10.3390/curroncol33040218
“Individuals with lower socioeconomic status consistently experience demonstrably reduced access to high-quality healthcare services, delayed diagnosis, and inferior treatment quality across diverse diseases and care settings [2].”
Leivaditis, V., Mitsos, S., Mulita, F., Maniatopoulos, A. A., Baikoussis, N. G., Shaska, E., Andrikopoulou, C., Liolis, E., Skoura, T., Antzoulas, A., et al. (2026) · Medical Sciences · doi:10.3390/medsci14020277
“These factors may contribute to a preference for less invasive or more conservative management strategies, even when more definitive interventions would be clinically appropriate [10,12].”
InfluentialEthical Care Begins With Wellbeing: Reframing Nursing Practice Within Inequitable Systems
Gaskins, J., Waite, R. L., & Iheduru-Anderson, K. C. (2026) · Nursing Inquiry · doi:10.1111/nin.70126
“As one synthesis noted, healthcare professionals rely on implicit associations to “fill the gaps” when time and cognitive resources are limited (Job et al. 2024).”
Douma, E., van den Houdt, S. C. M., Kop, W. J., & Kupper, N. (2026) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2026.112906 · Cited by 1 · see citing works
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de Kok, J. W. T. M., Koornneef, D. J. M., Termorshuizen, F., Schnabel, R. M., van der Horst, I. C. C., de Keizer, N. F., Brinkman, S., & van Bussel, B. C. T. (2026) · Critical Care Medicine · doi:10.1097/ccm.0000000000007271
“Although they cannot directly address financial or societal risk factors, they can improve outcomes through tailored communication that overcomes language and knowledge barriers (71, 73, 74).”
Abshorshori, N., Mosallanezhad, M., Abaszadeh, F., et al. (2026) · Journal of Patient Experience · doi:10.1177/23743735261473778
“27,28 This pattern highlights how patient-provider interactions are shaped by broader social determinants.”
Lack of medical communication and patient safety
Mead, D. R., & Rios, I. P. (2026) · The Nurse Practitioner · doi:10.1097/01.npr.0000000000000464
Haghighathoseini, A., Wojtusiak, J., Min, H., & Menon, N. M. (2026) · JMIR Formative Research · doi:10.2196/88406 · Cited by 1 · see citing works
“…gaps—including the lack of standardized cohort construction criteria [30,31] and the limited validation of models against diverse benchmarks [32,34]—this study presents a comprehensive examination of how varying cohort construction decisions influence the performance and fairness of ML models…”
Kotz, K. J., Gilgoff, R., Gassen, J., Bhushan, D., Schuetz, J. P., Barrera, W., McClendon, D., & Slavich, G. M. (2026) · Family Medicine and Community Health · doi:10.1136/fmch-2026-003963
“10 109”
Osteoporosis Treatment Gap — A Systematic Literature Review
Rogina, K. G., Petravić, L., & Oikonomidis, C. (2026) · Slovenian Journal of Public Health · doi:10.2478/sjph-2026-0022
“Additionally, health professionals’ implicit bias against patients with low SES has a negative effect on clinical decision-making (68).”
Khalil, H. M., Guo, Y. M., Bian, J., Guo, J. S., Yang, S., Lou, X., Scarton, L. J., Rogers, S. C., Wilkie, D. J., DeRemer, D. L., et al. (2026) · Cancer Control · doi:10.1177/10732748261491721
- Authors
- Job, C., Adenipekun, B., Cleves, A., Gill, P., & Samuriwo, R.
- Affiliations
- Cardiff University (GB)
- Northumbria University (GB)
- Edinburgh Napier University (GB)
- Corresponding author
- Job, Claire
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2024-07
- Volume
- 14
- Issue
- 7
- Pages
- e081723
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC11227794
- OpenAlex
- W4400304242
- Cited by
- 44
- References
- 118
- Citations by year
- 2026: 26 · 2025: 16 · 2024: 2
- FWCI
- 19.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- PubMed Central (submittedVersion, cc-by-nc)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- implicit bias, socioeconomic status, healthcare workers, clinical decision-making, stereotyping, health disparities, intersectionality, cognitive load, low-income patients
- MeSH terms
- Clinical Decision-Making, Low Socioeconomic Status, Attitude of Health Personnel, Health Personnel, Humans, Social Class, Healthcare Disparities
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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