The Impact of Primary Care Providers’ Bias on Depression Screening for Lesbian Women

Primary care providers’ (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs’ implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs’ implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs ( n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women ( p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers’ awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan

Patients with cancer have widely divergent experiences throughout their care from screening through survivorship. Differences in care delivery and outcomes may be due to varying patient preferences, patient needs according to stage of life, access to care, and implicit or explicit bias in care according to patient age. NCCN convened a series of stakeholder meetings with patients, caregivers, and patient advocacy groups to discuss the complex challenges and robust opportunities in this space. These meetings informed the NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan held on December 10, 2020, which featured a keynote presentation, multidisciplinary panels, and presentations from patient advocacy organizations. This article encapsulates and expounds upon the findings from the stakeholder meetings and discussions during the summit.

Medical Student Choices Regarding Ventilator Allocation for People With Disabilities

In the COVID-19 pandemic, concerns exist that ventilator triage policies may lead to discrimination against people with disabilities. This study evaluates whether preclinical medical students demonstrate bias towards people with disabilities during an educational ventilator-allocation exercise. Written student responses to a triage simulation activity were analyzed to describe ventilator priority rankings and to identify themes regarding disability. Disability status was not cited as a reason to withhold a ventilator. Key themes observed in ventilator triage decisions included life expectancy, comorbidities, and social worth. Although disability discrimination has historically been perpetuated by health care professionals, it is encouraging that preclinical medical students did not demonstrate explicit bias against people with disabilities in ventilator triage scenarios.

The Neuroscience of Gender Bias within Organisations: Implicit and Explicit Influences

<p>It has been 30 years since the metaphor of a ‘glass ceiling’ was introduced, yet progress to address gender bias in organisations has been slow. Within a context in which employment is rapidly changing and technologies are enabling new ways of working, gender bias in organisations remains a persistent and complex issue that requires new ways of thinking. This study integrates across two scientific disciplines: social cognitive neuroscience and complex adaptive systems, in order to examine the complex nature of gender bias in organisations and advance implications for practice. The central proposition underlying this study is that the gender composition of a person’s ‘in-group’, that is the group of people one most closely relates to in a work setting, has implications for their level of gender bias. The relationship between in-group composition and gender bias is examined from implicit (unconscious) and explicit (conscious) bias perspectives. The composition of in-group is measured by homogeneity, size and trust, and is captured within an integrated instrument that includes measures of implicit and explicit bias. The study is informed by the theory of interactive person construal. It is proposed that biases are a dynamic, continuously evolving phenomena emerging from top down and bottom up cues. Specifically, the essence of this research is the relationship between the neuroscientific dynamics of in-group and out-group differentiation within the human brain and the complex systemic nature of the modern workplace. The study endeavours to make a contribution to the understanding of how people who share common values and interests (ingroup) influence gender bias in organisations. The research has been conducted in a professional services organisation. A group of people within the organisation were asked to participate in an online survey to capture implicit bias, explicit bias, composition of their in-group and demographic details. This research applied a quantitative survey methodology. The aims of the study are to: • examine the relationship between in-group composition and gender bias building from theoretical insights from neuroscience and complex adaptive systems theory, • test both implicit and explicit attitudes towards gender bias, • test the relationship between implicit and explicit measures of bias, and • provide a contribution to theory and practice in relation to addressing the issue of gender bias in organisations. It is concluded that there is a statistically significant association between in-group composition and the manifestation of implicit and explicit bias using a variety of measures. The model of in-group composition developed for this study could be used as a means to understand gender system dynamics. A dynamic systems model of bias is proposed based on the research variables and complexity ideas examined in the study. For organisations, this research has implications for how the issue of gender bias should be approached. Connecting ideas from social cognitive neuroscience and complex adaptive systems, this research highlights the interrelationship between recurring levels (neural, individual, group, organisation) within the bias system and the nature of interventions that may lead to enduring change.</p>

The Neuroscience of Gender Bias within Organisations: Implicit and Explicit Influences

<p>It has been 30 years since the metaphor of a ‘glass ceiling’ was introduced, yet progress to address gender bias in organisations has been slow. Within a context in which employment is rapidly changing and technologies are enabling new ways of working, gender bias in organisations remains a persistent and complex issue that requires new ways of thinking. This study integrates across two scientific disciplines: social cognitive neuroscience and complex adaptive systems, in order to examine the complex nature of gender bias in organisations and advance implications for practice. The central proposition underlying this study is that the gender composition of a person’s ‘in-group’, that is the group of people one most closely relates to in a work setting, has implications for their level of gender bias. The relationship between in-group composition and gender bias is examined from implicit (unconscious) and explicit (conscious) bias perspectives. The composition of in-group is measured by homogeneity, size and trust, and is captured within an integrated instrument that includes measures of implicit and explicit bias. The study is informed by the theory of interactive person construal. It is proposed that biases are a dynamic, continuously evolving phenomena emerging from top down and bottom up cues. Specifically, the essence of this research is the relationship between the neuroscientific dynamics of in-group and out-group differentiation within the human brain and the complex systemic nature of the modern workplace. The study endeavours to make a contribution to the understanding of how people who share common values and interests (ingroup) influence gender bias in organisations. The research has been conducted in a professional services organisation. A group of people within the organisation were asked to participate in an online survey to capture implicit bias, explicit bias, composition of their in-group and demographic details. This research applied a quantitative survey methodology. The aims of the study are to: • examine the relationship between in-group composition and gender bias building from theoretical insights from neuroscience and complex adaptive systems theory, • test both implicit and explicit attitudes towards gender bias, • test the relationship between implicit and explicit measures of bias, and • provide a contribution to theory and practice in relation to addressing the issue of gender bias in organisations. It is concluded that there is a statistically significant association between in-group composition and the manifestation of implicit and explicit bias using a variety of measures. The model of in-group composition developed for this study could be used as a means to understand gender system dynamics. A dynamic systems model of bias is proposed based on the research variables and complexity ideas examined in the study. For organisations, this research has implications for how the issue of gender bias should be approached. Connecting ideas from social cognitive neuroscience and complex adaptive systems, this research highlights the interrelationship between recurring levels (neural, individual, group, organisation) within the bias system and the nature of interventions that may lead to enduring change.</p>

Leading While Female: A Personal Journey

Growth in the administrative function of universities along with the fragility of academic culture creates challenges for academic leaders invested in change. In my own case, these challenges were compounded by my gender: my status as an immigrant woman in a leadership role. In this chapter I outline the basic requirements of a democratic culture—allowing individuals to preserve their identity while positively contributing to the community in which they're embedded—and question the gender stereotypes that see men but not women as “naturally” suited to leadership. This prejudice can translate into implicit or even explicit bias and discrimination when women attempt to fill roles that historically have been reserved for men, and thereby violate gender expectations. As a consequence, women leaders may be marginalized and their authority resisted or unrecognized. This chapter is a personal journey detailing my own experiences of “leading while female.”

How Communicating about Discrimination Influences Attributions of Blame and Condemnation

Across two randomized experiments, we examine how communication about discriminatory acts can influence judgments of blame and condemnation. Specifically, we consider whether attributing discrimination to implicit or explicit bias affects how people evaluate online reports of discrimination. In Study 1 (N = 947), we explore this question in the context of an online news environment, and in Study 2 (N = 121) we replicate our results on a social media site (i.e., Twitter). Across both studies, we document how viewers respond differently to reports of discrimination due to variation in agent motives, the type of bias that purportedly caused the discriminatory behavior, and the extent to which agents are reported to have completed implicit bias training. We discuss our theoretical contribution to perspectives of blame attribution and the communication of bias as well as the practical implications of our findings.

Disorders of Consciousness and the Disability Critique

Some members of disability communities and activist organizations have strenuously objected to the withdrawal of life-sustaining treatment from persons in the vegetative state/unresponsive wakefulness syndrome, notably in the case of Terri Schiavo. A history of medical neglect and ableism prompts reasonable fears that the rights of disabled persons are threatened by the withdrawal of treatment from patients who lack the ability to decide for themselves. This chapter considers the disability critique of the right to die. Implicit and explicit bias against disabled persons, and the withdrawal of treatment as a means to prevent disability are examined, alongside concerns about epistemic injustice and questions about who has the epistemic authority to speak for those with disorders of consciousness. What we owe to profoundly impaired persons, including those with disorders of consciousness, is what we owe to others: care, careful consideration of their preferences and interests, and respect for their personhood.

Attitudes, Knowledge, and Behavior

This chapter is a review of the relevant literature on effecting changes in attitudes and behaviors toward people with disabilities. It begins with a discussion of the goals of the book and the activities in the book. There is discussion of the relationship between attitudes and behaviors, and whether a change in one is followed by a change in the other. The core research about the bases of attitudes toward disability and attitude change is reviewed. The move in the past few decades from attention to implicit bias to focus on explicit bias is highlighted. The rationale for not using simulation exercises is provided, as well as the social underpinnings of the activities.