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The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma
Open accessAbstract
Objectives. We examined the association between pediatricians’ attitudes about race and treatment recommendations by patients’ race. Methods. We conducted an online survey of academic pediatricians (n = 86). We used 3 Implicit Association Tests to measure implicit attitudes and stereotypes about race. Dependent variables were recommendations for pain management, urinary tract infections, attention deficit hyperactivity disorder, and asthma, measured by case vignettes. We used correlational analysis to assess associations among measures and hierarchical multiple regression to measure the interactive effect of the attitude measures and patients’ race on treatment recommendations. Results. Pediatricians’ implicit (unconscious) attitudes and stereotypes were associated with treatment recommendations. The association between unconscious bias and patient’s race was statistically significant for prescribing a narcotic medication for pain following surgery. As pediatricians’ implicit pro-White bias increased, prescribing narcotic medication decreased for African American patients but not for the White patients. Self-reported attitudes about race were associated with some treatment recommendations. Conclusions. Pediatricians’ implicit attitudes about race affect pain management. There is a need to better understand the influence of physicians’ unconscious beliefs about race on pain and other areas of care.
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“eight articles appeared to refer to the same data collected in a single cross-country comparison study [27–32, 34, 35] and a further two articles analysed the same data [45, 47].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [45]
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“Four studies examining the correlation between IAT scores and responses to clinical vignettes found a significant correlation between high levels of pro-white implicit bias and treatment responses that favoured patients specified as white [42, 45–47].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [45]
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“, 2018 [59] USA Mental illness bias IAT Cross-sectional online-study with 4 IATs on attitude (good/bad), permanence, controllability, and ethology of mental illness (depression/ physical illness) 86 Physicians, psychiatrists Weak–moderate negative UB on attitude, permanence, and controllability against mentally ill pe…”
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“In addition, postsurgical narcotic medications were prescribed less frequently for African American children with pain, again associated with a pro-white bias (107).”
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“This aligns with previous work showing that providers with a pro-White implicit bias are more likely to recommend care for White than Black patients [13, 14].”
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“…report pain – including suspicion of the person reporting pain, cultural/racial stereotypes, and implicit biases – affect perceptions of others’ pain, and contribute to unfavorable pain treatment decisions and patient outcomes (van Ryn et al., 2011; Sabin and Greenwald, 2012; Wandner et al., 2012).”
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Brief online implicit bias education increases bias awareness among clinical teaching faculty
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“Implicit bias among providers is associated with poor clinical interactions and disparities in healthcare [6,7,9,10] but does not appear to impact the benefits of implicit bias education.”
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“(14) Despite older reports of lower levels of pro-white implicit bias among pediatricians compared to adult providers, more recent studies have found significant levels of implicit racial bias indeed exist within the field,(15,16) and these have been shown to be associated with disparate treatment recommendations for…”
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From understanding to action: interventions for surgical disparities.
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“When compared with White patients, Black patients are less likely to receive a prescription for pain (Sabin & Greenwald, 2012), less likely to receive breast and colorectal cancer screening (Rao, Breen, & Graubard, 2016), more likely to experience amputation as a result of diabetes (Trawalter,…”
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“…among physicians is associated with disparities in quality care, including lower likelihood of evidence-based prescribing, withholding pain medication, and lower quality interpersonal care for Black compared with White patients (Green et al., 2007; Cooper et al., 2012; Sabin and Greenwald, 2012).”
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Racial and Ethnic Disparities in Bronchiolitis Management in Free-Standing Children’s Hospitals
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Metadata
- Authors
- Sabin, J. A., & Greenwald, A. G.
- Affiliations
- University of Washington (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2012-05
- Volume
- 102
- Issue
- 5
- Pages
- 988-995
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC3483921
- OpenAlex
- W2078029714
- Cited by
- 525
- References
- 0
- Citations by year
- 2026: 21 · 2025: 32 · 2024: 46 · 2023: 48 · 2022: 78 · 2021: 54 · 2020: 53 · 2019: 37 · 2018: 37 · 2017: 34 · 2016: 25 · 2015: 26 · 2014: 19 · 2013: 11 · 2012: 2
- FWCI
- 61.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- American Journal of Public Health
- Funders
- University of Washington
- Agency for Healthcare Research and Quality (R36 HS015676, 1-R36HS1576-01)
- National Institute of Mental Health (T32MH20010, T32MH020010)
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Keywords
- implicit bias, racial bias in medicine, pediatricians, treatment guidelines, pain management, urinary tract infection, attention deficit hyperactivity disorder, asthma, racial disparities, African American patients, opioid prescribing, Implicit Association Test, racial stereotypes
- MeSH terms
- Central Nervous System Stimulants, Analgesics, Opioid, Asthma, Attention Deficit Disorder with Hyperactivity, Attitude of Health Personnel, Black or African American, Counseling, Female, Health Services Research, Humans, Male, Pediatrics, Prejudice, Referral and Consultation, Stereotyping, Urinary Tract Infections, White People, Healthcare Disparities, Pain Management
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