Bias Flashcards
(157 cards)
1
Q
Cognitive expectancies about an out group are…
A
Stereotypes
2
Q
‘All people with obesity lack self control’ this is a…
A
Stereotype
3
Q
…. Is an emotional reaction to someone on the basis of group membership.
A
Prejudice
4
Q
‘People with obesity disgust me’ is an example of what?
A
Prejudice
5
Q
…is the behavioural demonstration of stereotyping and prejudice.
A
Discrimination
6
Q
In the context of health care, discrimination is…
A
Denial of equality of treatment
7
Q
Inequality in healthcare is seen in…
A
Access to treatment and outcomes.
8
Q
Who experience increased death and disability and reduced productivity as a result of reduced access and treatment?
A
Minority groups
9
Q
…has declined sharply over the past 50 years.
A
Trust in the medical profession
10
Q
The media means we are more aware of…
A
Medical errors
11
Q
Decreased trust in the medical profession may be in part due to…
A
An increase in patient centred care approaches.
12
Q
Experience of bias may be an additional factor in…
A
Reduced trust in the medical profession.
13
Q
Give two examples of groups routinely stigmatised outside of health care
A
Obese people and disabled people
14
Q
What are the impacts of obesity stigma on health?
A
Depression, anxiety, low self esteem and perpetuation of eating problems
15
Q
… Is central to how obese people feel about themselves.
A
Experience of bias
16
Q
What are the outcomes of stigma for disabled people
A
Social isolation and depression
17
Q
Institutional bias is…
A
Bias that is inherent to the system
18
Q
The NHS’ first guiding principle is:
A
Equitable treatment regardless of race, ethnicity etc. Is a patient right’
19
Q
If you get to a stage of obesity where your health is at real risk, you may be eligible for…
A
Bariatric surgery
20
Q
A requirement for before getting bariatric surgery is…
A
Losing five percent of your body weight
21
Q
The arbitrary figure of 5% weight loss for bariatric surgery is routinely justified with what argument?
A
It is necessary to shrink your liver and the health programme prepares people for life after surgery.
22
Q
What does NICE say about bariatric surgery, which differs from practice?
A
NICE says we should give bariatric surgery more routinely and to people with lower BMI
23
Q
Name a group who routinely experiences institutional bias in healthcare
A
Older adults
24
Q
Older adults are less likely to get the medication and tests they need (ref?)
A
Callahan et al., 2000
25
Older adults are less likely to report experiencing positive clinical interactions (ref?)
Hajjij et al., 2010
26
With an aging population, we would expect older people to receive...
More input from health care professionals and more access to treatment.
27
The BMJ editorial on institutional racism in mental health had how many participants?
32000
28
The BMJ editorial on institutional racism in mental health found that ... Percent of inpatients are BME, while only ... Percent of the population is BME
21, 7
29
BME mental health patients are more likely to...
Be sectioned, stay in hospital for longer
30
BME HCPs are...
Concentrated in lower paid jobs and over represented in cases of misconduct
31
Personality mediated bias is...
Individually based differential treatment on the basis of group membership, at the level if the 1:1 clinical interaction.
32
Give an example of how elderly people are excluded from health promotion.
GPs are more likely to advise improved health behaviours (not smoking, drinking less, eating more healthily, exercising) to younger patients.
33
Which age group is excluded from drug and BCI trials?
80+
34
What did the 2003 IOM report find?
BME patients receive fewer procedures and poorer quality care, even when accounting for variations, e.g. Insurance, disease severity, income and education, which are known to affect healthcare.
35
Endorsement of stereotypes...
Has decreased dramatically over the past few decades.
36
___________ found that social norms are correlated with prejudice.
Crandall et al., 2002
37
Based on Crandall et al's (2002) findings, it is clear that explicit expression of discrimination is structured by
Social norms
38
What do the GMC principles say about bias?
Doctors must not refuse or delay treatment because they believe a patients actions have contributed to their condition. Doctors must not unfairly discriminate against patients by allowing their personal views to affect the treatment they provide or arrange.
39
Most doctors enter the profession to...
Help people. I.e. They are not deliberately biased.
40
Bias with in medicine is predominantly...
Implicit.
41
Implicit bias is typically assessed using the...
IAT
42
The IAT measures...
How strongly people associate social categories with positive/negative evaluations/stereotypes.
43
In the IAT, bias is measured through...
Speed of responding to paired associations.
44
Slower responding in the IAT...
Indicates slower processing, presumably of pairs which are inconsistent with expectation.
45
At graduation, all doctors...(ref?)
Take the Hippocratic oath, vowing to respect and treat all patients as individuals. (Chapman, 2013)
46
Implicit pro-White bias has been demonstrated across cultures from the age of... (Ref?)
3 years old. (Baron et al., 2015)
47
As we age our______bias decreases but our ______bias stays the same (ref?)
Explicit, implicit (baron et al., 2015)
48
Who gave evidence for reducing institutional bias through increased bias literacy?
Carnes et al., (2012)
49
What did Carnes et al. (2012) do/find/give a limitation.
Bias literacy workshop with 200 university staff, interviewed 24 between 4 and 6 months later/75% demonstrated increased bias awareness and intended to or had changed their behaviours as a direct result of the workshop. This study did not assess the effects of bias literacy on implicit institutional bias.
50
What were the three main areas of bias research in HC, identified by chapman et al. (2013)
1. Bias in health care professionals
2. The effects of bias on treatment
3. The effects of bias on patients
51
Bias in HCPs: implicit bias against obese people in qualified doctors does not correlate with explicit bias (ref?)
Schwartz (2003)
52
Bias in HCPs: implicit racial bias in qualified doctors is not correlated with explicit bias (ref?)
Sabin (2008)
53
Bias in HCPs is also seen at the trainee level (ref?)
White-means (2009)
54
While implicit bias is present across society it is...
Arguably more of a problem in health care.
55
The effects of bias on treatment: chest pain vignette study, black or white, asked to rate ...... And recommend ......(gree, 2007)
Pain and treatment (green, 2007)
56
The effects of bias on treatment: chest pain vignette study, black or white, pain was rated... (Ref?)
The same for both - no sign of explicit bias. (Green, 2007)
57
The effects of bias on treatment: chest pain vignette study, black or white, treatment recommended was...(Green, 2007)
More often thrombosis is for white than black patients - evidence of implicit bias in treatment. (Green, 2007)
58
The effects of bias on patients: White and black patients are deemed to have similar pain levels but are differentially recommended to receive pain medication (ref?)
Todd (2000)
59
Relatives of black end-of-life patients rate care quality lower. (Ref?)
Welch et al. (2005)
60
Non white patients evaluate consultations as less satisfactory (ref?)
Barr (2004)
61
Bias in doctors is positively associated with being evaluated as...(ref?)
Less warm and friendly (Penner et al., 2010)
62
Implicit bias in doctors is associated with...(ref?)
Lower patient satisfaction (Cooper et al., 2012)
63
_______ resources are important in explaining why bias occurs in health care.
Attentional
64
Who introduced the idea of the cognitive miser?
Fiske & Taylor (1984)
65
What does 'cognitive miser' refer to?
The human propensity to do 'just enough' mental work to function
66
Relying on stereotypes is __________ than forming individualised impressions.
Mentally easier.
67
Stereotype based impressions are ____________ that are not likely to be true for everyone.
over-simplifications/heuristics
68
There is, however, a ______ for group based processing.
Valid role
69
Activation of a stereotype is...
perceiving someone in terms of their category membership rather than individual attributes = when stereotypes are triggered.
70
Stereotype application is...
Treating someone based on category membership (e.g. expressing bias - discrimination)
71
_________ (e.g. through word completion tasks) takes up attentional resources and can inhibit stereotype activation (ref?)
Cognitive loading (Gilbert & Hixon, 1991)
72
If cognitive loading occurs at the same time as a ________, this increases the likelihood that stereotypes are activated.
Perceiver goal
73
What is a perceiver goal?
When a person has a goal in any given situation which is to do with fulfilling their own identity needs.
74
What perceiver goal may occur in a clinical situation?
The doctor's salient 'doctor' identity may activate the goal of role performance as a doctor, leading to ready activation of stereotypes.
75
Who conducted a review on the application of stereotypes?
Sherman et al., (1996)
76
The application of stereotypes is ________ and requires little _______. (ref?)
Automated, effort (Sherman et al., 1996)
77
Individuation is _______ and compromised by ______. (ref?)
effortful (resource heavy), high cognitive load (Sherman et al., 1996).
78
It can take considerable effort no to _______ stereotypes once they are _______.
apply, activated (Sherman et al., 1996)
79
Participants who were not under high cognitive load could readily inhibit application of active stereotypes, those under cognitive load couldn't - even when they were motivated to do so. (ref?)
Wyer et al. (2000)
80
What factors contribute to doctors cognitive load? (Particularly applicable in A&E settings)
Little is known about patients, they are responsible for multiple patients at once, they have to make urgent decisions and decisions about urgency, complex decision making is required.
81
What kinds of things contribute to the complexity of doctors decision making/cognitive load? (Ref?)
Patient preference, history, test ordering decisions, interpreting test results, treatment options and knowledge, allocation of resources, costs, administration responsibilities. (Croskerry, 2002)
82
Who wrote a review on the five pitfalls in decisions about diagnosis and prescribing?
Klein (2005)
83
What are the five pitfalls in diagnosis and prescribing? (Ref?)
The representativeness heuristic, availability bias, overconfidence, confirmatory bias and illusory correlation (Klein, 2005).
84
What is representativeness heuristic?
'If something is similar to other things in a category it belongs in that category'
85
Name and describe a study of the representativeness heuristic
Kahneman & Tversky (1973) study - 30% engineers, 70% lawyers.
86
Name and describe a study which demonstrates the representativeness heuristic in nursing (Ref?).
Brannon & Carson (2003) nurses given description of patient symptoms (MI or Stroke) with or without extra information (recently fired or smelt of alcohol). Both trainee and qualified nurses were more likely to make the diagnosis when the extra information was not included. Demonstrates the use of representativeness heuristics.
87
What is availability bias?
The tendency to look for evidence that fits the most available stereotype and omit important information that doesn't.
88
Give an example of availability bias in medicine (REF?)
Poses (1991) Recent exposure to caring for patients with bacteraemia made doctors more likely to judge future patients as having bacteraemia.
89
What recommendation does Klein (2005) make for minimising representativeness bias in clinicians?
It is important to be aware of base rate occurrences of diseases at bring this to bear in decisions.
90
What recommendation does Klein (2005) make for minimising availability bias in medicine?
Clinicians should try to be aware of their susceptibility to this bias and consider whether the information they are using to make judgements is relevant or just salient.
91
Give an example of overconfidence in medicine (ref?)
Primary care doctors and oncologists rated their ability to manage pain highly, despite demonstrating shortcomings in attitudes and knowledge about pain control (Larue et al., 1995)
92
What recommendation does Klein (2005) make for minimising overconfidence in medicine?
Clinicians should be aware of and address the limits of their knowledge.
93
How does the GMC contribute to the management of overconfidence in clinicians.
The GMC guidelines require physicians to identify and address their own CPD needs.
94
In what situation is it useful to rely on heuristics?
When we have high cognitive load.
95
Most of the time heuristics are _________ but sometimes they can cause problems and lead to _________
useful/errors.
96
According to the Institute of Medicine report (date?) BME patients receive fewer ________ and ________ care.
(2003) procedures, poorer quality.
97
Measures of discrimination are inversely related to multiple indicators of ________. (ref?)
disease and poor health practices. (Williams & Wyatt, 2015).
98
Exposure to discrimination is associated with increased risk of ________ (ref?)
CVD, hypertension and MHP (Williams & Wyatt, 2015)
99
Perceived discrimination leads to ______________ (ref?)
decreased help seeking and adherence (Williams & Wyatt, 2015).
100
In order to improve the health out comes for diverse populations we need to... (ref?)
Raise awareness, enhance diversity in healthcare and use policy to increase opportunity and acceptability of health promoting behaviours as within the in-group behaviour repertoire (Williams & Wyatt, 2015).
101
Reducing bias - in clinical training, a lot of effort is put in to make sure that doctors are...
equitable, compassionate and competent.
102
Reducing bias - there is evidence that simply _________ of cognitive biases is a positive step towards tackling them (ref?)
being aware of (Beck, 2011)
103
Simply raising awareness of bias only addresses stereotype _________ and not ________.
application/activation.
104
Work has shown that identifying bias as a 'natural _________' is a good way to encourage doctors to override it (ref?).
habit of mind (Green et al., 2007).
105
Reducing bias - what is decategorisation? (ref?)
One area of efforts to reduce bias. It is about encouraging doctors to adapt an interpersonal rather than intergroup focus. Perceiving the other as an individual and making a complex personal impression. (Brewer and Miller, 1984).
106
Reducing bias - __________ is a strategy which is difficult to apply in a busy clinical setting.
Decategorisation
107
Reducing bias - Outside of healthcare, training people to ________ has been shown to reduce bias. This may help with decategorisation in HCPs (REF?)
differentiate between outgrip faces (Lebrecht et al., 2009).
108
Reducing bias - what is stereotype suppression? (ref?)
One tactic for reducing bias. It is about ignoring stereotypes that are activated. (Monteith et al., 1998)
109
Reducing bias - What is the problem with stereotype suppression? (REF?)
In order to suppress, we first need to activate. Research suggests that activation and then suppression leads to increased accessibility of the suppressed concept later (rebound effect) (Macrae et al., 1994).
110
Reducing bias - What is recategorisation?
This strategy for reducing bias aims to alter the salient basis for categorisation.
111
Reducing bias - What is the first approach to recategorisation?
Cross categorisation - raising awareness of shared group membership
112
Reducing bias - What is the second approach to recategorisation?
Common in-group identity - raising salience of a broader superordinate category
113
the strategy of _________ has influenced successful programmes which reduce bias. These programs have positive effects on the _______ and ______ underpinning bias (ref?). (Not yet really shown in health care)
Recategorisation. Cognitions/motivations (Gaertner & Dovidio, 2000).
114
Reducing bias - what is perspective taking? (ref)
This has been used in healthcare training and is about imagining the other persons situation (Galinsky & Moskowitz, 2000)
115
Reducing bias - What are the effects of perspective taking? (ref?)
Promotes a sense of self other 'oneness', promotes empathy (Batson et al., 1997).
116
Reducing bias - What are the effects of perspective taking in health care (positive) (ref?).
Nurses offer equal pain relief to minority/majority patients after a perspective taking task (Drwecki, 2011).
117
Reducing Reducing bias - What are the effects of perspective taking in health care (not positive) (refsx2?).
Perspective taking only works for those not committed to the in-group (Tarrant et al., 2012).
Anticipation of being evaluated in an intergroup encounter can lead perspective taking to backfire (Vorauer et al., 2009).
118
Preliminary research suggests you can target implicit social biases using __________ during _______ (ref?).
cognitive bias modification/sleep (Hu et al., 2015).
119
Practising _________ can reduce implicit race and age bias (ref?).
Mindfulness meditation (Luke & Gibson, 2015).
120
Selective treatment - when is it acceptable?
Transplants offered you children and young adults as a priority.
121
Being actively patient centred involves _________ and improves ______________(ref?).
Including patients in clinical decisions/ adherence and better outcomes (Robinson et al., 2008).
122
In older people _______ is treated as less serious (Ref?).
Depression and suicidality (Uncupher, 2000)
123
In older people ___________ is offered less frequently (ref?).
Breast cancer surgery (Madan, 2006).
124
Showing picture of ____ black and _____ whites reduces pro-white implicit bias. (ref?)
admired/disliked (Dasgupta & Greenwald., 2001).
125
Women who regularly see a female doctor are more likely to have had ______________ (ref?)
A mammogram/cervical smear (Franks & Clancy, 1993).
126
Female physicians show less implicit ______ bias (ref?)
gender (Sabin et al., 2009).
127
Trust in the medical profession has declined: In 1966 _____% of US population said that they had great confidence in leaders of the medical profession, by 2014 this had fallen to _____% (REF?)
75%/23% (Blendon et al., 2014)
128
Who reported that GPs were more likely to ask about smoking and alcohol consumption habits, and more likely to give advice about smoking to 55 year olds than to otherwise identical 75 year olds presented to them on video clips?
Arber et al. (2004)
129
Older adults are less likely to get the specialist care they need. Describe Bond et al.'s (2003) study.
They performed an analysis of 712 case notes and found that older patients with ischemic heart disease, and with indications for further treatment, were less likely to be referred for exercise tolerance tests, angiography and cardiac catheterisation.
130
Describe Baron et al's (2015) study on bias as we age.
They tested explicit (self report) and implicit (IAT) racial bias in 6 year olds, 10 year olds and adults. There was implicit and explicit bias in 6 year olds, implicit and less explicit in 10 year olds and implicit but virtually no explicit in adults.
131
Bias in HCPs: Describe Scwartz (2003) study on implicit/explicit anti-fat bias.
Study among 389 qualified doctors (obesity specialists). IAT and explicit self report bias measure showed implicit pro-thin/anti-fat bias, this was moderated by personal characteristics namely: lower levels of anti fat bias were associated with - being male, being older, having obese friends, being heavier and expressing understanding of the experience of obesity.
132
Bias in HCPs: Describe Sabin's (2008) study on implicit/explicit racial bias.
Paediatricians associate European American patients more strongly with ‘compliant patient’. They also showed general pro-white bias (though less so than other types of doctors) and this was not correlated with explicit self report of bias.
133
The effects of bias on treatment: Describe Bogarts (2001) study on black patients and associations with HIV non-adherence
New medications for HIV reduce mortality and morbidity but require strict adherence. Physicians must make decisions about disease severity and likelihood of adherence when deciding to start a patient on treatment. 495 doctors, surveyed by mail, responded to clinical scenarios depicting HIV-positive patients and indicated whether they would start patients on medication (response rate = 53%). Physicians predicted that African American men would be less likely to adhere, and they were less likely to start them on treatment.
134
The effects of bias on patients: Describe Todd's (2000) study on the differential analgesic treatment of white and black patients
217 patients, of whom 127 were black and 90 were white. White patients were significantly more likely than black patients to receive ED analgesics (74% versus 57%,) despite similar records of pain complaints in the medical record. This effect persisted after controlling for multiple confounders and echoed earlier work by the authors on biased treatment of Hispanic patients.
135
The effect of bias on patients: Give more information about Welch et al's (2005) study of end of life care.
Across 22 states, family members of AA patients were statistically less likely than whites to rate the care received as excellent or good (N = 1,447)
136
The effect of bias on patients: Give more information on Barr's (2004) study of patient satisfaction as a function of race.
Five hundred thirty-seven primary care patients selected at random from those entering a medical office. The 4-item, physician-specific scale indicated that nonwhite patients were less satisfied than white patients with their direct interaction with the physicians included in the study.
137
Describe the findings of Penner et al's (2010) study re: aversive racism.
Black patients had less positive reactions to medical interactions with physicians relatively low in explicit but relatively high in implicit bias, compared with all other combinations of high/low explicit/implicit bias.
138
The effect of bias on patients: Give more information on Cooper et al's (2012) study on patient satisfaction as a function of race.
a cross-sectional study of 40 primary care clinicians and 269 patients. Implicit race bias, race and compliance stereotyping were measured, these were then related to audio tape recordings of visits and patient ratings. Among Black patients, general race bias was associated with more clinician verbal dominance, lower patient positive affect, and poorer ratings of interpersonal care; race and compliance stereotyping was associated with longer visits, slower speech, less patient centeredness, and poorer ratings of interpersonal care.
139
Describe the evidence from Gilber and Hixon (1991) that cognitive loading can inhibit stereotype activation.
Experiment 1 - Participants saw a video of either a white or an asian research holding up cards with the beginning of words on them, which could be completed either stereotypically or not. Those who were not cognitively busy were more likely than those who had to rehearse an 8-digit number simultaneously to make stereotypical words.
140
Describe the evidence from Gilber and Hixon (1991) that cognitive loading can enhance stereotype application.
When stereotype activation was allowed to occur, busy Ss (who performed a visual search task during their exposure) were more likely to apply these activated stereotypes than were not-busy Ss). This may go some way to explaining the negative perceptions of aversive racists - they are perhaps trying and failing to suppress implicit racism, and therefore this means it is activated.
141
Stereotype activation is more likely when a perceiver goal is present: Stangor et al (1992) found that processing goals affected categorisation on the basis of ___________.
Clothing style
142
Stereotype activation is more likely when a perceiver goal is present: Spencer et al (1998) showed that...
even resource-depleted perceivers are capable of activating categorical knowledge structures, if such activation can enhance their feelings of self-worth/self-image.
143
It can be extremely difficult not to apply stereotypes, even when we are motivated not to, if we are cognitively busy. Describe Pendry & Macrae's (1994) study
Participants who were made outcome-dependent on their impressions of a woman were more likely to identify individuating information about her, but only when not cognitively busy.
144
Stereotypes can dissipate with ____________. (REF?)
Lengthy encounters (Kunda, 2002)
145
Availability bias: Give more detail about Poses' (1991) study.
Subjects of the study were 227 medical inpatients in a university hospital who had blood cultures done. Estimates of the probabilities that individual patients would have positive blood cultures were collected from the house officers who ordered the cultures. Those who had been in most contact with bacteraemia recently gave greater probabilities.
146
Overconfidence: Give more detail about LaRue's (1995) study.
Telephone study of 600 PCPs and 300 oncologists, Although 85% of primary care physicians and 93% of medical oncologists express satisfaction with their own ability to manage cancer pain, 76% of primary care physicians and 50% of medical oncologists report being reluctant to prescribe morphine for cancer pain.
147
Decategorisation: Describe Prati et al's (2016) studies (1 and 2)
Study 1 showed that perceiving members of a rival university along multiple versus simple categorical dimensions enhanced the tendency to attribute human traits to this group. Study 2 showed that multiple versus simple categorization of immigrants increased the attribution of uniquely human emotions to them. This effect was explained by increased individuation of the outgroup and reduced outgroup threat.
148
Decategorisation: Describe Lebrecht et al's (2009) study in more detail
Two groups of caucasian participants were exposed to the same AA faces over 5 sessions. In the individuation condition, subjects learned to distinguish between the faces, in the categorisation condition they were required to categorise them as AA or non-AA. The individuation group showed improved distinguishing between novel AA faces, they also showed decreased implicit racial bias. These two outcomes were also significantly correlated, suggesting improved ability to individuate was the driver of reduced bias.
149
Recategorisation: Who developed the 'Common Ingroup Identity' model?
Gartner and Dovidio (2000)
150
Recategorisation: Identify and describe a study which gave empirical support for the Common Ingroup Identity model.
Nier et al (2001) conducted a field experiment conducted at the University of Delaware football stadium. Interviewers (either White or Black) approached White football fans wearing either a home team hat (the common ingroup identity condition) or an away team hat (the control condition). Football fans complied with Black interviewers more when the interviewer was wearing the home team hat, suggesting that (Black) outgroup members were treated more favourably when they were perceived to share a more inclusive common ingroup identity.
151
Perspective taking: Describe Wandner et al's (2015) study
In a virtual reality experiment, 96 physicians took part and were more likely to rate pain higher and prescribe opioids after a brief perspective taking intervention.
152
Perspective taking : Describe the findings of Tarrant et al (2012)
Compared with less committed members, those who identified highly with the in-group used a greater number of negative traits to describe the out-group following perspective taking. Such perspective taking also led participants with high in-group identification to judge the out-group less favorably.
153
Novel ways to decrease bias: Describe Hu et al's (2015) study
40 participants processed counter stereotype information paired with one sound for each type of bias. During subsequent sleep, a specific sound was played unobtrusively for each participant, corresponding bias was reduced - this was maintained at 1 week follow up.
154
Novel ways to decrease bias: Describe Luecke's (2015) study
Mindfulness for reducing bias. Participants listened to a mindfulness or control audio then completed age and race IATS, mindfulness group showed decreased age and race bias, supporting evidence that mindfulness can help people to rely less on previously established associations.
155
Depression and suicidality are treated as less serious in older populations: Describe uncupher's (2000) study.
A vignette study of 215 primary care providers. The patient presented with depression and suicidality, the only difference was half of them got a patient who was 38 and half 78. The physicians in this study recognized depression and suicidal risk in both the adult and the geriatric vignette, but they reported less willingness to treat the older suicidal patient compared with the younger patient.
156
Breast cancer surgery is offered to 90% of 50-70 year olds but only 58% of over 70s (ref?)
Madden et al. (2006)
157
Superordinate recategorisation and empathy: Describe Tarrant and Header's (2010) study
Participants read a scenario in which an out-group member (socially stigmatised group) talking about being in that group. they were then asked to describe their feelings towards this group and another group. Experiencing empathy for the stigmatised group created positive attitudes which generalised to other group - but only if the other group was from the same superordinate category.
