“Treat everyone fair, respect each other, no matter what race, now repeat”: Informatics opportunities for promoting equitable patient-centered clinical interactions for patients from marginalized groups (Preprint)

Abstract

Implicit bias in healthcare impacts clinicians' behaviors and can lead to health inequities for Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) patients. Prior work has developed tools aimed at raising clinician awareness of potential implicit bias and improving interactions with patients, particularly those from marginalized communities. However, there is a gap in understanding what patients consider to be promising strategies to improve their interactions with clinicians and promote patient-centered, equitable care.

To build upon our previous work identifying dimensions of implicit bias in clinical interactions, this study aims to characterize patient-generated strategies for improving interactions between clinicians and BIPOC and LGBTQ+ patients. By focusing on patients' perspectives, we advance beyond clinician-centered approaches to address implicit bias and promote equitable, patient-centered care.

We recruited a diverse sample of BIPOC and LGBTQ+ adults (n=25) through institutional networks, social media, and community champions. Sample size was determined by thematic saturation. Semi-structured remote interviews were conducted to gather insights on strategies for enhancing interactions with clinicians. We employed inductive thematic analysis, involving iterative coding and theme development, to identify emergent patient-generated strategies for improving clinical interactions and addressing implicit bias. The analysis continued until consensus was reached among the research team.

Participants generated five strategies for mitigating implicit bias and promoting equitable patient-centered interactions with clinicians: (1) giving feedback to clinicians, (2) having a patient advocate, (3) enhancing clinicians' training, (4) diversifying healthcare workforce, and (5) amplifying positive experiences. These strategies offer novel, patient-centered approaches to addressing implicit bias in healthcare. Participants emphasized the need for anonymous feedback systems, culturally competent patient advocates, and comprehensive bias recognition training for clinicians. They also highlighted the importance of increasing diversity in the healthcare workforce and leveraging positive experiences to model effective patient-clinician interactions. Notably, participants suggested using technology to facilitate real-time communication monitoring and provide digital patient advocacy, offering innovative solutions to longstanding challenges in healthcare equity.

Understanding patient priorities for addressing implicit biases in clinical interactions is vital for developing effective strategies to promote patient-centered care. These findings advance related work by providing patient-generated opportunities to improve clinician-patient relationships, moving beyond clinician-focused interventions. Researchers and healthcare professionals can leverage these insights to design interventions that empower patients and foster equitable relationships between clinicians and individuals from marginalized communities. Future research should focus on co-designing and evaluating tools with patients and clinicians to implement these strategies effectively, with particular attention to overcoming power imbalances and improving communication in clinical settings.