Page 22 - ASCO Cultural Competency Toolkit

IMPLICIT AND COGNITIVE BIAS IN HEALTHCARE
Unconscious Bias Awareness
Cognitive biases are “unconscious influences, short-cuts, and behaviors which influence our decision making” (O’Sullivan, 2019).
A key reason we develop such biases is that our brains have a natural tendency to look for patterns and
associations in order to make sense of our complex world and surroundings. In healthcare, it is important that clinicians are aware of their various types of implicit biases, as acting on implicit biases may perpetuate systemic inequalities and can cause negative healthcare interactions.
Research suggests that healthcare clinicians’ diagnostic and management decisions, and overarching thoughts about patients, are influenced by patients’ race or ethnicity. (Smedley BD, et al, Schulman et al. 1999). Implicit bias may contribute to incomplete history gathering, diagnostic delay, misdiagnosis, poor patient management, and health care disparities (Royce, Hayes, et al, 2019). In these ways, implicit bias can impact a clinician’s clinical reasoning and decision-making, and has been shown to negatively impact health care outcomes (Blair IV, et al, 2019).
There are various types of unconscious bias that may impact healthcare interactions, with examples listed below (Royce, Hayes, et al, 2019):
▪ Confirmation bias: ▪ Anchoring: a
. ▪ Framing:
. ▪.
Bias Mitigation Strategies
Recognizing, understanding, and addressing bias in healthcare is an important step toward achieving health equity. Racial bias and stereotypes are more likely to influence a healthcare clinician’s memory, decision-making, and behaviors when their cognitive capacity is overtaxed (“high cognitive load”) (Van Ryn 2011)). Clinic scenarios that create a high cognitive load include time pressure, productivity pressures, high noise levels, inadequate staffing, poor feedback and supervision, inadequate training, and high communication load. Physician stress and time pressures have been associated with increased medical errors and suboptimal patient care. Being able to apply bias mitigation strategies in an optometric practice can improve patient-doctor interactions and patient satisfaction, and ultimately help reduce healthcare disparities. Some bias mitigation strategies in a healthcare setting have been described in the table below (Van Ryn M 2011).
towards people of certain groups without our conscious knowledge. (Gopal, et al, 2021).
new information
looking for confirming evidence to support a hypothesis rather
than seeking disconfirming evidence to refute it.
fixation on specific features of a patient’s initial presentation, failure to adjust with
decisions affected by the clinical context in which a problem is considered or by the
analysis provided by a prior clinician
Ascertainment: thinking shaped by what the physician hopes or expects to find
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Implicit bias is described as having attitudes, evaluations, or associations
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