Implicit Racial Bias in Evaluation of Neonatal Opiate Withdrawal Syndrome.

Implicit bias Neonatal opiate withdrawal syndrome Neonate

Journal

Journal of racial and ethnic health disparities
ISSN: 2196-8837
Titre abrégé: J Racial Ethn Health Disparities
Pays: Switzerland
ID NLM: 101628476

Informations de publication

Date de publication:
18 Dec 2023
Historique:
received: 22 08 2023
accepted: 29 11 2023
revised: 20 11 2023
medline: 19 12 2023
pubmed: 19 12 2023
entrez: 19 12 2023
Statut: aheadofprint

Résumé

To assess implicit bias by administrating the Modified Finnegan Score (MFS) for quantifying neonatal opiate withdrawal and to evaluate risk of decreased opiate treatment of Black versus White infants. Study participants were nurses recruited from a large tertiary care center who received three clinical vignettes portraying withdrawing infants and were randomized to receive an accompanying photo of either a Black or White infant. MFS results were compared for identical vignettes based on race of infant photo. Out of 275 nurses, 70 completed the survey. In vignette 2, nurses aged ≤35 years scored Black infants lower than White infants (MFS=8.3 ± 2 vs. 9.5 ± 1.2, p=0.012). Nurses with <5 years of experience and ≤10 years of experience also scored Black infants lower for the same vignette (8.2 ± 2.3 vs. 9.6 ± 1.2, p=0.032 and 8.3 ± 2 vs. 9.5 ± 1.2, p=0.0083). Implicit bias may contribute to the difference in opiate treatment.

Identifiants

DOI: 10.1007/s40615-023-01887-w PMID: 38110799
pubmed: 38110799
doi: 10.1007/s40615-023-01887-w
pii: 10.1007/s40615-023-01887-w
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. W. Montague Cobb-NMA Health Institute.

Références

Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. America: Equity and Equality in Health 3 Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389 Accessed: Nov. 15, 2022. [Online]. Available: www.thelancet.com/
Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DWM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2020;87(2):227. https://doi.org/10.1038/S41390-019-0513-6 .
doi: 10.1038/S41390-019-0513-6 pubmed: 31357209
Phelan SM, et al. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring). 2014;22(4):1201–8. https://doi.org/10.1002/OBY.20687 .
doi: 10.1002/OBY.20687 pubmed: 24375989 pmcid: 3968216
Greenwald AG, Banaji MR. Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychol Rev. 1995;102(1):4–27. https://doi.org/10.1037/0033-295X.102.1.4 .
doi: 10.1037/0033-295X.102.1.4 pubmed: 7878162
Vela MB, Erondu AI, Smith NA, Peek ME, Woodruff JN, Chin MH. Eliminating explicit and implicit biases in health care: evidence and research needs. Annu Rev Public Health. 2022;43:477. https://doi.org/10.1146/ANNUREV-PUBLHEALTH-052620-103528 .
doi: 10.1146/ANNUREV-PUBLHEALTH-052620-103528 pubmed: 35020445 pmcid: 9172268
Hall WJ, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60. https://doi.org/10.2105/AJPH.2015.302903 .
doi: 10.2105/AJPH.2015.302903 pubmed: 26469668 pmcid: 4638275
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–301. https://doi.org/10.1073/PNAS.1516047113 .
doi: 10.1073/PNAS.1516047113 pubmed: 27044069 pmcid: 4843483
Mathur VA, Richeson JA, Paice JA, Muzyka M, Chiao JY. Racial bias in pain perception and response: experimental examination of automatic and deliberate processes. J Pain : official J Am Pain Soc. 2014;15(5):476. https://doi.org/10.1016/J.JPAIN.2014.01.488 .
doi: 10.1016/J.JPAIN.2014.01.488
Benzing AC, Bell C, Derazin M, Mack R, MacIntosh T. Disparities in opioid pain management for long bone fractures. J Racial Ethn Health Disparities. 2020;7(4):740–5. https://doi.org/10.1007/S40615-020-00701-1 .
doi: 10.1007/S40615-020-00701-1 pubmed: 32378160
Kennel J, Withers E, Parsons N, Woo H. Racial/ethnic disparities in pain treatment: evidence from Oregon Emergency Medical Services Agencies. Med Care. 2019;57(12):924–9. https://doi.org/10.1097/MLR.0000000000001208 .
doi: 10.1097/MLR.0000000000001208 pubmed: 31730566
Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996. https://doi.org/10.1001/JAMAPEDIATRICS.2015.1915 .
doi: 10.1001/JAMAPEDIATRICS.2015.1915 pubmed: 26366984 pmcid: 4829078
Nafiu OO, Chimbira WT, Stewart M, Gibbons K, Porter LK, Reynolds PI. Racial differences in the pain management of children recovering from anesthesia. Paediatr Anaesth. 2017;27(7):760–7. https://doi.org/10.1111/pan.13163 .
doi: 10.1111/pan.13163 pubmed: 28504322 pmcid: 5474946
Wing E, Saadat S, Bhargava R, Yun H, Chakravarthy B. Racial disparities in opioid prescriptions for fractures in the pediatric population. Am J Emerg Med. 2022;51:210–3. https://doi.org/10.1016/j.ajem.2021.10.017 .
doi: 10.1016/j.ajem.2021.10.017 pubmed: 34775193
Jilani SM, et al. Standardizing the clinical definition of opioid withdrawal in the neonate. J Pediatr. 2022;243:33–39.e1. https://doi.org/10.1016/j.jpeds.2021.12.021 .
doi: 10.1016/j.jpeds.2021.12.021 pubmed: 34942181
Sarkar S, Donn SM. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J Perinatol. 2006;26:15–7. https://doi.org/10.1038/sj.jp.7211427 .
doi: 10.1038/sj.jp.7211427 pubmed: 16355103
Parikh A, Gopalakrishnan M, Azeem A, Booth A, El-Metwally D. Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome. J Perinatol. 2019;39(10):1370–6. https://doi.org/10.1038/s41372-019-0440-8 .
doi: 10.1038/s41372-019-0440-8 pubmed: 31388115
Pourcyrous M, Elabiad MT, Rana D, Gaston KP, Debaer L, Dhanireddy R. Racial differences in opioid withdrawal syndrome among neonates with intrauterine opioid exposure. Pediatr Res. https://doi.org/10.1038/s41390-020-01279-4 .
Grossman MR, Berkwitt AK, Osborn RR. Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome: thinking beyond genetics. J Perinatol. 2020;40(4):689–90. https://doi.org/10.1038/S41372-020-0607-3 .
doi: 10.1038/S41372-020-0607-3 pubmed: 32076112
R. R. S. Clark and R. French, “Conflating race and genetics among newborns with neonatal abstinence syndrome,” JAMA Pediatr., 176, no. 1, pp. 12–13, Jan. 2022, doi: https://doi.org/10.1001/JAMAPEDIATRICS.2021.3591 .
Fitzgerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1) https://doi.org/10.1186/S12910-017-0179-8 .
Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–80. https://doi.org/10.1037//0022-3514.74.6.1464 .
doi: 10.1037//0022-3514.74.6.1464 pubmed: 9654756
Smedley A, Smedley BD. Race as biology is fiction, racism as a social problem is real: anthropological and historical perspectives on the social construction of race. Am Psychol. 2005;60(1):16–26. https://doi.org/10.1037/0003-066X.60.1.16 .
doi: 10.1037/0003-066X.60.1.16 pubmed: 15641918
Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015:h4672. https://doi.org/10.1136/bmj.h4672 .
Patrick SW, et al. Neonatal opioid withdrawal syndrome. Pediatrics. 2020;146(5) https://doi.org/10.1542/peds.2020-029074 .
US Food and Drug Administration, “Neonatal opioid withdrawal syndrome and medication-assisted treatment with methadone and buprenorphine,” Available at: https://www.fda.gov/Drugs/DrugSafety/ucm503630.htm .
Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here? Perm J. 2011;15(2):71–8. https://doi.org/10.7812/TPP/11.979 .
doi: 10.7812/TPP/11.979 pubmed: 21841929 pmcid: 3140753
Bartel AP, Beaulieu ND, Phibbs CS, Stone PW. Human capital and productivity in a team environment: evidence from the healthcare sector. Am Econ J Appl Econ. 2014;6(2):231–59. https://doi.org/10.1257/app.6.2.231 .
doi: 10.1257/app.6.2.231
L. H. Aiken, “Educational levels of hospital nurses and surgical patient mortality,” JAMA: J Am Med Assoc., 290, 12, pp. 1617–1623, Sep. 2003, doi: https://doi.org/10.1001/jama.290.12.1617 .
Audet L-A, Bourgault P, Rochefort CM. Associations between nurse education and experience and the risk of mortality and adverse events in acute care hospitals: a systematic review of observational studies. Int J Nurs Stud. 2018;80:128–46. https://doi.org/10.1016/j.ijnurstu.2018.01.007 .
doi: 10.1016/j.ijnurstu.2018.01.007 pubmed: 29407346
Cheung RB, Aiken LH, Clarke SP, Sloane DM. Nursing care and patient outcomes: international evidence. Enferm Clin. 2008;18(1):35–40. https://doi.org/10.1016/S1130-8621(08)70691-0 .
doi: 10.1016/S1130-8621(08)70691-0 pubmed: 18218265 pmcid: 2856593
Gomez-Pomar E, et al. Analysis of the factors that influence the Finnegan Neonatal Abstinence Scoring System. J Perinatol. 2017;37(7):814–7. https://doi.org/10.1038/JP.2017.40 .
doi: 10.1038/JP.2017.40 pubmed: 28383539
Kushnir A, Saslow JG, Stahl G, Bleznak JL. Nurses’ Finnegan Scoring of newborns with neonatal abstinence syndrome not affected by time or day of the week. Am J Perinatol. 2020;37(2):224–30. https://doi.org/10.1055/S-0039-1698458 .
doi: 10.1055/S-0039-1698458 pubmed: 31600793
Timpson W, Killoran C, Maranda L, Picarillo A, Bloch-Salisbury E. A quality improvement initiative to increase scoring consistency and accuracy of the Finnegan tool: challenges in obtaining reliable assessments of drug withdrawal in neonatal abstinence syndrome. Adv Neonatal Care. 2018;18(1):70–8. https://doi.org/10.1097/ANC.0000000000000441 .
doi: 10.1097/ANC.0000000000000441 pubmed: 29045256 pmcid: 5786483
“HHS announces a standard clinical definition for opioid withdrawal in infants | HHS.gov.” Accessed: Mar. 21, 2023. [Online]. Available: https://www.hhs.gov/about/news/2022/01/31/hhs-announces-standard-clinical-definition-for-opioid-withdrawal-in-infants.html
Tajeu GS, et al. Development of a multicomponent intervention to decrease racial bias among healthcare staff. J Gen Intern Med. 2022;37(8):1970–9. https://doi.org/10.1007/s11606-022-07464-x .
doi: 10.1007/s11606-022-07464-x pubmed: 35266123 pmcid: 9198170
Joseph OR, Flint SW, Raymond-Williams R, Awadzi R, Johnson J. Understanding healthcare students’ experiences of racial bias: a narrative review of the role of implicit bias and potential interventions in educational settings. Int J Environ Res Public Health. 2021;18(23) https://doi.org/10.3390/IJERPH182312771 .

Auteurs

Katherine Nyman (K)

University of California San Diego School of Medicine, San Diego, CA, USA.
Division of Neonatology, Rady Children's Hospital, San Diego, CA, USA.

Francesca Okolie (F)

University of Maryland Medical Center, Baltimore, MD, USA.
Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA.

Natalie L Davis (NL)

University of Maryland Medical Center, Baltimore, MD, USA.
Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA.

Erin Hager (E)

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Dina El-Metwally (D)

University of Maryland Medical Center, Baltimore, MD, USA. dmetwally@som.umaryland.edu.
Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD, S-512, USA. dmetwally@som.umaryland.edu.
ORCID: 0000-0003-1394-6789

Classifications MeSH