背景:黑人患者之间的医学不信任已被用来解释在生命结束时存在有据可查的种族不平等现象,这对该群体产生了负面影响。然而,在严重疾病的背景下,很少有研究描述关于种族主义和歧视性经历对不信任的影响的患者观点。
目的:为了更好地描述重病患者中种族主义和歧视的经历及其与医疗不信任的关系。
方法:72名患有严重疾病的黑人参与者在一所学术县医院住院。
方法:这是一项融合的混合方法研究,使用来自参与者完成的调查和现有的半结构化访谈的数据,激发参与者对医学种族主义经历的看法,通信,和决策。
方法:医学种族主义的经验及其与基于群体的医学不信任(GBMM)量表评分的关联,一种经过验证的医疗不信任措施。
结果:在72名黑人参与者中,35%参加了面试。参与者大多是有显著社会经济劣势的男性,包括低水平的财富,收入,和教育程度。据报道,在GBMM量表的总体得分中,基于种族的不信任程度很高(平均值[SD],36.6[9.9]),以及在怀疑范围内的高分(14.2[5.0]),医疗保健方面的群体差异(9.9[2.8]),和缺乏支持(9.1[2.7])分量表。三个定性主题与GBMM子量表一致。参与者对医护人员(HCWs)和现代医学表示怀疑,讲述了医疗环境中歧视的个人经历,并且对来自HCW的沟通不畅感到沮丧。
结论:这项研究发现,患有严重疾病的黑人患者之间存在高度的不信任。对HCWs的怀疑,按种族划分的医疗保健差距,缺乏HCW的支持是影响医疗不信任的首要主题。Critical,需要有种族意识的方法来创建战略和框架,以提高医疗机构和工作人员的可信度。
BACKGROUND: Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at the end of life that negatively impact this group. However, there are few studies that describe patient perspectives around the impact of racism and discriminatory experiences on mistrust within the context of serious illness.
OBJECTIVE: To better characterize experiences of racism and discrimination among patients with serious illness and its association with medical mistrust.
METHODS: Seventy-two Black participants with serious illness hospitalized at an academic county hospital.
METHODS: This is a convergent mixed methods study using data from participant-completed surveys and existing semi-structured interviews eliciting participants\' perspectives around their experiences with medical racism, communication, and decision-making.
METHODS: The experience of medical racism and its association with Group-Based Medical Mistrust (GBMM) scale scores, a validated measure of medical mistrust.
RESULTS: Of the 72 Black participants, 35% participated in interviews. Participants were mostly men who had significant socioeconomic disadvantage, including low levels of wealth, income, and educational attainment. There were reported high levels of race-based mistrust in the overall GBMM scale score (mean [SD], 36.6 [9.9]), as well as high scores within the suspicion (14.2 [5.0]), group disparities in healthcare (9.9 [2.8]), and lack of support (9.1 [2.7]) subscales. Three qualitative themes aligned with the GBMM subscales. Participants expressed skepticism of healthcare workers (HCWs) and modern medicine, recounted personal experiences of discrimination in the medical setting, and were frustrated with poor communication from HCWs.
CONCLUSIONS: This study found high levels of mistrust among Black patients with serious illness. Suspicion of HCWs, disparities in healthcare by race, and a lack of support from HCWs were overarching themes that influenced medical mistrust. Critical, race-conscious approaches are needed to create strategies and frameworks to improve the trustworthiness of healthcare institutions and workers.