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Miner DC, Ailey SH, Thompson RA, Squires A, Adarlo A, Brown H. "We have met the enemy and it is us": Healthcare professionals as the barrier to health equity for people with intellectual and developmental disability. Res Nurs Health 2024; 47:269-273. [PMID: 38415432 DOI: 10.1002/nur.22376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Dianne C Miner
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
| | - Sarah H Ailey
- Rush University College of Nursing, Chicago, Illinois, USA
| | - Roy A Thompson
- Preparing Future Faculty for Inclusive Excellence Postdoctoral Fellow, Sinclair School of Nursing, University of Missouri, Kansas City, Missouri, USA
| | - Allison Squires
- NYU Rory Meyers College of Nursing, New York, New York, USA
- Department of General Internal Medicine, Grossman School of Medicine, New York City, New York, USA
- National Academy of Medicine, Washington, District of Columbia, USA
| | - Amyela Adarlo
- Loma Linda University, School of Nursing, Loma Linda, California, USA
- Gamma Alpha Chapter of Sigma Theta Tau International, Indianapolis, Indiana, USA
| | - Holly Brown
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
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2
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Friedman C, VanPuymbrouck L, Gordon Z. 'Not seeing people as capable': Disability professionals' mis/understandings of ableism. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13218. [PMID: 38403303 DOI: 10.1111/jar.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Knowledge about how disability professionals understand ableism may provide insight into the production of inequalities. The aim of this study was to examine how disability professionals understand ableism. METHODS We asked 347 disability professionals, all of whom worked with people with intellectual and developmental disabilities, among other populations, to define ableism and then analysed those definitions using content analysis. RESULTS The themes about how participants understood ableism were: discrimination; differential treatment; individualization; norms and othering; ableist language; microaggressions; and systems and environments. It was also not uncommon for participants to say ableist things, and express misconceptions in their definitions. This included these themes: avoiding disability; using ableist language; framing disability as in/ability; centring people without disabilities; ignoring invisible disabilities; believing only people without disabilities have bias; and believing ableism does not exist. CONCLUSIONS Knowing disability professionals' understandings of ableism is necessary to intervene biased attitudes and reduce ableism.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership (CQL), Towson, Maryland, USA
| | | | - Zach Gordon
- American Association on Intellectual and Developmental Disabilities (AAIDD), Silver Spring, Maryland, USA
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Mannor KM, Needham BL. The study of ableism in population health: a critical review. Front Public Health 2024; 12:1383150. [PMID: 38694970 PMCID: PMC11061527 DOI: 10.3389/fpubh.2024.1383150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024] Open
Abstract
Over the past three decades, health equity has become a guiding framework for documenting, explaining, and informing the promotion of population health. With these developments, scholars have widened public health's aperture, bringing systems of oppression sharply into focus. Additionally, some researchers in disability and health have advocated for utilizing socially grounded frameworks to investigate the health of disabled people. Yet, naming ableism, much less operationalizing it for the empirical study of health, remains scant. This paper critically reviews the study of ableism as a social determinant of disabled people's health within population health research. First, we provide an orientation to the present state of this literature by looking to the past. We briefly trace a history of traditional approaches to studying disability and health and alternatives that have emerged from critiques of the individualized lens that has dominated this work. Next, we delineate the operation of ableism across social levels. We characterize how ableism has been studied in population health in terms of levels of analysis (intrapersonal, interpersonal, institutional, and structural) and measures of interest. To conclude, we discuss hinderances to and promising avenues toward population health research that advances health equity for disabled people.
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Affiliation(s)
- Kara M. Mannor
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
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4
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Landes SD, Swenor BK, Vaitsiakhovich N. Counting disability in the National Health Interview Survey and its consequence: Comparing the American Community Survey to the Washington Group disability measures. Disabil Health J 2024; 17:101553. [PMID: 37981492 DOI: 10.1016/j.dhjo.2023.101553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The objective of the National Health Interview Survey (NHIS) is to provide data that can be used to monitor the health of the US population. OBJECTIVE In this study, we evaluate whether the disability questions currently used in the NHIS - the Washington Group questions - threaten the ability of this survey to fulfil its stated objective for disabled people. METHODS Data were from the 2011-2012 NHIS with linkage to mortality status through 2019. We examined whether people who reported a disability in the American Community Survey disability questions had their disability counted in the Washington Group questions. We then examined the consequence of use of the Washington Group as opposed to the American Community Survey questions, on estimates of disability prevalence and comparative mortality risk. RESULTS We find that when compared to their predecessor, the American Community Survey disability questions, the Washington Group questions accounted for less than half of disabled people, primarily counting disabled people with more than one disability status, but not counting many disabled people with only one disability status. As a result of this undercount, disability prevalence rates based on the Washington Group questions underestimate the size of the disabled population in the US, and overestimate the comparatively higher mortality risk associated with disability status. CONCLUSIONS These results underscore the need to re-evaluate the disability questions used in the NHIS, and invest in the development of improved and expanded disability questionnaires for use in national surveys.
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Affiliation(s)
- Scott D Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, 314 Lyman Hall, Syracuse, NY, 13244, USA.
| | - Bonnielin K Swenor
- The Johns Hopkins Disability Health Research Center, Baltimore, MD, 21287, USA; Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nastassia Vaitsiakhovich
- Department of Sociology and Lerner Center for Public Health Promotion and Population Health, Maxwell School of Citizenship and Public Affairs, Syracuse University, NY, 13244, USA.
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5
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Derbyshire DW, Keay T. "But what do you really think?" Nurses' contrasting explicit and implicit attitudes towards people with disabilities using the implicit association test. J Clin Nurs 2024. [PMID: 38454558 DOI: 10.1111/jocn.17097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
AIMS To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers. METHOD We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021. DATA SOURCES We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/. REPORTING STROBE checklist. RESULTS There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD-among all groups-has not improved over the 15 year period of our sample. CONCLUSIONS We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently. IMPLICATIONS We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding. PATIENT OR PUBLIC CONTRIBUTION There is no patient or public contribution.
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Affiliation(s)
- Daniel W Derbyshire
- Department of Public Health and Sports Science, University of Exeter, Exeter, UK
| | - Tamsin Keay
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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6
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Carew MT, Dhingra S, Bash-Taqi R, Koroma HK, Fraser T, McLaren M, Groce N. "These attitudes are a pressure": women with disabilities' perceptions of how stigma shapes their sexual health choices. CULTURE, HEALTH & SEXUALITY 2024; 26:362-376. [PMID: 37247199 DOI: 10.1080/13691058.2023.2212285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/06/2023] [Indexed: 05/30/2023]
Abstract
Women with disabilities face numerous barriers to achieving sexual health on an equitable basis to others, including stigma about disability and sexuality. Yet, how specific stigmatising beliefs about disability and sexuality influence the choices women with disabilities make about their sexual health has not been studied widely. The present study sought to address this gap in the context of Sierra Leone. Semi-structured interviews were conducted with women with disabilities (N = 32) and women without disabilities (N = 10). Societal stigma of disability linked with witchcraft was seen as a deterrent to accessing sexual and reproductive health services. Stigma about women with disabilities as burdens and about childless women with disabilities as pitiable were perceived as sources of pressure on disabled women's reproductive choices. Concurrently, women with disabilities rejected common stigmatising beliefs held about their lives. Results are discussed in terms of practical implications for healthcare providers and policymakers in Sierra Leone.
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Affiliation(s)
- Mark T Carew
- Policy & Research, Leonard Cheshire Disability, London, UK
- UCL International Disability Research Centre, University College London, London, UK
| | - Smriti Dhingra
- Policy & Research, Leonard Cheshire Disability, London, UK
| | | | | | - Tania Fraser
- Institute for Development, Freetown, Sierra Leone
| | - Megan McLaren
- Technical Services Department, MSI Reproductive Choices UK, London, UK
| | - Nora Groce
- UCL International Disability Research Centre, University College London, London, UK
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7
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Rule ARL. Ensuring the Future of Pediatrics Is Inclusive of Disability. Hosp Pediatr 2024; 14:e173-e176. [PMID: 38389464 DOI: 10.1542/hpeds.2023-007608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Amy R L Rule
- Division of Neonatology and Pediatric Hospital Medicine, Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia
- Neonatal and Pediatric Hospitalist Children's Healthcare of Atlanta, Atlanta, Georgia
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Peabody Smith A, Feinsinger A. Extending patient-centred communication to non-speaking intellectually disabled persons. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109671. [PMID: 38373830 DOI: 10.1136/jme-2023-109671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
Patient-centred communication is widely regarded as a best practice in contemporary medical care, both in terms of maximising health outcomes and respecting persons. However, not all patients communicate in ways that are easily understood by clinicians and other healthcare professionals. This is especially so for patients with non-speaking intellectual disabilities. We argue that assumptions about intellectual disability-including those in diagnostic criteria, providers' implicit attitudes and master narratives of disability-negatively affect communicative approaches towards intellectually disabled patients. Non-speaking intellectually disabled patients may also be taken to lack decision-making capacity and resultingly, may be given very little role in determining their care. But, given evidence of the heterogeneous communicative practices available to non-speaking patients, efforts should be made to extend patient-centred communication to them. We offer four suggestions for doing so: (1) treating those with non-speaking intellectual disabilities as potential communicators; (2) lengthening appointment times to develop relationships necessary for communication; (3) disentangling capacity from communication in concept and in practice; and (4) recognising the bidirectional connection between supported decision-making and patient-centred communication.
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Affiliation(s)
- Ally Peabody Smith
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
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Church PT, Dahan M, Rule A, Janvier A, Stewart JE, Maypole JS, Fehlings D, Litt JS, Banihani R. NICU Language, Everyday Ethics, and Giving Better News: Optimizing Discussions about Disability with Families. CHILDREN (BASEL, SWITZERLAND) 2024; 11:242. [PMID: 38397354 PMCID: PMC10887718 DOI: 10.3390/children11020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
The Neonatal Intensive Care Unit (NICU) has a language and culture that is its own. For professionals, it is a place of intense and constant attention to microdetails and cautious optimism. For parents, it is a foreign place with a new and unique language and culture. It is also the setting in which they are introduced to their child and parenthood for this child. This combination has been referred to as an emotional cauldron. The neonatal ethics literature mainly examines complex ethical dilemmas about withholding/drawing life sustaining interventions for fragile children. Rarely are everyday ethics or mundane ethics discussed. Microethics describe the mundane, discrete moments that occur between patients/families and clinicians. A key piece of these microethics is the language used to discuss patient care. Perception of prognoses, particularly around long-term neurodevelopmental outcome, is shaped with the language used. Despite this, clinicians in the NICU often have no specific training in the long-term neurodevelopment outcomes that they discuss. This paper focuses on the microethics of language used to discuss long-term neurodevelopmental outcomes, the developmental neuroscience behind language processing, and offers recommendations for more accurate and improved communication around long-term outcomes with families with critically ill neonates.
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Affiliation(s)
| | - Maya Dahan
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada (R.B.)
| | - Amy Rule
- Children’s Healthcare of Atlanta, Atlanta, GA 30342, USA
| | | | - Jane E. Stewart
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (J.E.S.)
| | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G 1R8, Canada;
| | - Jonathan S. Litt
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (J.E.S.)
| | - Rudaina Banihani
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada (R.B.)
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10
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Lundberg DJ, Chen JA. Structural ableism in public health and healthcare: a definition and conceptual framework. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100650. [PMID: 38188095 PMCID: PMC10770745 DOI: 10.1016/j.lana.2023.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Dielle J. Lundberg
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jessica A. Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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11
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Shen J, Carmichael A, Clinton AJ. A scoping review of research on potential impact of implicit bias in healthcare settings for children with acquired brain injuries. Rehabil Psychol 2024; 69:36-44. [PMID: 37796578 PMCID: PMC10843613 DOI: 10.1037/rep0000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE/OBJECTIVE Acquired brain injury (ABI) is a leading cause of disability in children and adolescents. Implicit biases within pediatric ABI healthcare settings may exert negative effects on clinical interactions and medical decision-making processes. This study aimed to conduct a scoping review of current research that examines the potential impact of implicit biases in such healthcare settings for children with ABI. RESEARCH METHOD/DESIGN Following PRISMA-ScR guidelines, a search among five databases (CINAHL, Cochrane CENTRAL, PubMed, PsycArticles, and PsycInfo) was conducted, followed by abstract/full-text screening and data extraction. Main characteristics of the included studies, including research design, relevance to implicit biases, and public health impact were synthesized. The risk of bias of included studies was assessed. RESULTS Out of the 203 articles returned from the literature search, a total of three studies met the inclusion criteria for the present review. All studies examined the relevance of racial/ethnic biases for evaluating abusive head trauma or nonaccidental trauma. The included studies had an overall unclear to low risk of biases. CONCLUSIONS/IMPLICATIONS This scoping review identified scarce but emerging evidence of the presence and detrimental impact of potential implicit biases on the access and quality of care received by children with ABI. More research is needed to examine the causes, process mechanisms, and consequences of implicit biases in pediatric ABI healthcare settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Amanda Carmichael
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA
| | - Alexander J Clinton
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
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12
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Guthrie E, Charon R. Disability and narrative medicine: Challenges and opportunities. Dev Med Child Neurol 2024; 66:149-154. [PMID: 37390126 DOI: 10.1111/dmcn.15685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 07/02/2023]
Abstract
Despite decades of international entreaties for improvement, education about and provision of healthcare for people with disabilities remains harmfully inferior to that of the non-disabled population. Many obstacles confound efforts to ameliorate this inequity, perhaps the most pernicious of which is negative bias on the part of providers. Narrative medicine offers a means to address healthcare attitudes towards people with disabilities, in particular negative attitudes based on 'ableism'. Through absorbing, writing, and sharing of diverse perspectives, narrative medicine kindles imagination and empathy, promoting self-reflection. This approach enriches the students' capacity to absorb what their patients are trying to say, and to appreciate, respect, and hopefully meet the healthcare needs of people with disability. WHAT THIS PAPER ADDS: Narrative medicine is a pedagogical tool to help providers listen and reflect on patients with disabilities.
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Affiliation(s)
- Elisabeth Guthrie
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Rita Charon
- Columbia University Irving Medical Center, New York, NY, USA
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13
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Tolchin DW, Rushin C, Tolchin B, Slocum C, Meyerson JL, Havercamp SM, Keeney T, Schwartz AW, Schaefer K, Ross M, Stein MA, Jones CA, Rosa WE, Brooks FA. Top Ten Tips Palliative Care Clinicians Should Know About Providing Care for People With Disabilities. J Palliat Med 2024. [PMID: 38232708 DOI: 10.1089/jpm.2023.0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Palliative care (PC) clinicians are well poised to help people with disabilities (PWD) live well in the context of serious illness. PC prioritizes person-centered care with a focus on function, autonomy, and quality of life. This approach aligns with principles of high-quality care for PWD. An understanding of the unique experiences and needs of PWD can advance the delivery of comprehensive, equitable PC for this population. In this article, we provide 10 tips to help PC clinicians develop an informed disability lens in their approach to care.
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Affiliation(s)
- Dorothy W Tolchin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/MassGeneral Brigham/Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ben Tolchin
- Center for Clinical Ethics, Yale New Haven Health, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chloe Slocum
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/MassGeneral Brigham/Harvard Medical School, Boston, Massachusetts, USA
| | - Jordana L Meyerson
- Harvard Medical School, Boston, Massachusetts, USA
- Section of Geriatrics and Palliative Care, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Tamra Keeney
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea W Schwartz
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen Schaefer
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Care Dimensions Hospice, Danvers, Massachusetts, USA
| | - Melissa Ross
- Ross Psychotherapy, Arlington, Massachusetts, USA
| | - Michael A Stein
- Harvard Law School, Cambridge, Massachusetts, USA
- Harvard Law School Project on Disability, Cambridge, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Forrest A Brooks
- Department of Medicine, Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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14
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Kurtek P. Explicit and implicit attitudes of occupational therapy workshops' staff towards people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13171. [PMID: 37941324 DOI: 10.1111/jar.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/31/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
The aim of this article is to present explicit and implicit attitudes of occupational therapy (OT) staff towards people with intellectual disabilities. The study was conducted on a group of 77 OT employees. To explore the explicit attitude, the Conditional Respect for Persons with Disabilities Questionnaire (Kurtek, Roczniki Psychologiczne, 2018, 4, 327-344) was used, while to estimate the implicit attitude, the Intellectual Disability Attitudes Implicit Association Test was applied (Kurtek, Roczniki Psychologiczne, 2021, 1, 43-64). At the explicit level, OT staff tended to tolerate negative and overrate positive behaviours of people with intellectual disabilities, which indicates a tendency to favour the individuals. However, the opposite devalorizing tendency was observed at the implicit dimension, which indicates aversive ableism. Although the study confirmed the independence of the two dimensions of the personnel's attitude, relationships were observed between the disclosure of negativity towards antagonistic behaviours of the people with intellectual disabilities and a decrease in the level of their implicit devaluation.
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Affiliation(s)
- Paweł Kurtek
- Faculty of Education and Psychology, Jan Kochanowski University, Kielce, Poland
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15
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Meredith S, Weiss S, Kleinert HL, Tyrrell CA. The impact of implicit and explicit bias about disabilities on parent experiences and information provided during prenatal screening and testing. Disabil Health J 2024; 17:101514. [PMID: 37633732 DOI: 10.1016/j.dhjo.2023.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Prenatal screening technology has consistently raised concerns regarding the conversations and information provided about disabilities, particularly given that research shows trauma related to negative prenatal screening and diagnosis experiences among parents of children with Down syndrome.1 OBJECTIVE: To determine what information obstetric medical providers (OB/MFMs) are most and least likely to provide when delivering prenatal screening/testing results about Down syndrome (DS), the subsequent impact of bias on prenatal screening experiences, and how these issues can be addressed through training, resources, and professional guidelines. METHODS Online surveys were distributed to parents of children with DS born between 2016 and 2021 via local DS organizations and the national DS Diagnosis Network (April 2020-December 2021). RESULTS Of the 242 parents who completed the survey, a majority indicated that OB/MFMs were most likely to discuss medical issues and reproductive options while less than 40% reported that OB/MFMs discussed psychosocial outcomes, supports, and services. Respondents reported that the 61.3% of OB/MFMs who delivered the diagnosis as bad news or said "I'm sorry" were significantly less likely than their counterparts to provide information about life outcomes, supports and services, condition-specific resources, or more comprehensive prenatal care. Qualitative responses about screening/diagnosis experiences provided further context about the impact of implicit and explicit bias on the provision of accurate, up-to-date information. CONCLUSION To meet information needs during prenatal screening, OB/MFMs need access to accurate, balanced, and up-to-date information about disabilities and more training on disability cultural competency and how to deliver prenatal screening/testing results without implicit or explicit bias.
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Affiliation(s)
| | - Sierra Weiss
- University of Kentucky Human Development Institute, USA
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Lee D, Pollack SW, Mroz T, Frogner BK, Skillman SM. Disability competency training in medical education. MEDICAL EDUCATION ONLINE 2023; 28:2207773. [PMID: 37148284 PMCID: PMC10167870 DOI: 10.1080/10872981.2023.2207773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE Lack of health care providers' knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. METHOD Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. RESULTS Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. CONCLUSIONS Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.
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Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Samantha W Pollack
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
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Siegel J, McGrath K, Muniz E, Siasoco V, Chandan P, Noonan E, Bonuck K. Infusing intellectual and Developmental disability training into Medical School curriculum: a Pilot intervention. MEDICAL EDUCATION ONLINE 2023; 28:2271224. [PMID: 37859424 PMCID: PMC10591531 DOI: 10.1080/10872981.2023.2271224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Despite the rising prevalence of developmental disabilities (DD) in the US, there remains insufficient training for healthcare professionals to care for this medically underserved population - particularly adults. The National Inclusive Curriculum for Health Education (NICHE) aims to improve attitudes and knowledge towards people with intellectual and developmental disabilities (PWIDD); herein we describe one such intervention. METHOD The intervention integrated didactic, panel presentation and clinical skills components into a 2nd year medical school curriculum. The didactic session, covering health and assessment of PWIDDs, history of IDD, stigma, etc., was co-taught by a developmental pediatrician, family medicine physician and social worker. A panel of 3 adult self-advocates (SAs) with DD and a parent of a child with DD spoke about their lived experiences. One week later, students practiced taking clinical histories of SAs within small group settings with adult PWIDDs, facilitated by medical school faculty. Students completed the NICHE Knowledge(49 items) and Attitudes (60 items) surveys. The evaluation analyzed pre/post intervention differences in a) knowledge and attitude scores overall and b) by student age, gender, intended medical specialty, and prior experiences with PWIDDs. Open-ended comments were analyzed with content analysis. RESULTS Overall Knowledge scores increased from pre-to posttest (n = 85; 65[19] vs. 73[17], p = 0.00), while Attitudes score improved (i.e., decreased) (n = 88; 0.55 [.06] vs. 0.53 [0.06]); p = 0.00). Higher pretest knowledge was found among female identified students (vs. others; p = 0.01) and those knowing > = 5 PWIDD (vs < 5; p = 0.02). Students characterize their IDD training and experience prior to intervention as 'lacking' and described the sessions as effective. CONCLUSIONS A brief (4 hours total) intervention was associated with modest but significant improved knowledge and attitudes towards PWIDDs. Replication and sustainability of this and other NICHE interventions are needed to fill gaps in PWIDDs' health care.
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Affiliation(s)
- Joanne Siegel
- Department of Pediatrics, Co-director, Rose F. Kennedy Univeristy Center of Excellence (UCEDD) at Chidlren’s Evaluation and Rehabilitation Center (CERC), Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA
| | - Kathleen McGrath
- Department of Pediatrics, CERC/Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elisa Muniz
- Developmental-Behavioral Pediatrics Fellowship Program, Department of Pediatrics (Developmental Medicine), CERC/Rose F. Kennedy Center, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA
| | - Vincent Siasoco
- Department of Pediatrics (Developmental Medicine), Department of Family & Social Medicine, CERC/Rose F. KennedyCenter, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA
| | - Priya Chandan
- Healthcare Quality and Analytics, Kramer DavisHealth, Clinical Associate, Professor, Division of Physical Medicine & Rehabilitation, University of Louisville School of Medicine, Louisville, KY, USA
| | - Emily Noonan
- Department of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Karen Bonuck
- Department of Pediatrics, Co-director, Rose F. Kennedy Univeristy Center of Excellence (UCEDD) at Chidlren’s Evaluation and Rehabilitation Center (CERC), Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA
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18
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Friedman C, VanPuymbrouck L. People with Disabilities' Access to Medical Care During the COVID-19 Pandemic. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:373-386. [PMID: 38032296 DOI: 10.1080/19371918.2023.2288352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Delaying and forgoing medical care intensifies the health disparities and unmet needs people with disabilities already face. While many people with disabilities were at high risk for COVID-19, less is known about their access to medical care during the pandemic. This study explored people with disabilities' access to medical care during the COVID-19 pandemic. We analyzed United States Census Bureau COVID-19 Household Pulse Survey data from the second year of the pandemic (April-July 2021) from people with (n = 38,512) and without (n = 296,260) disabilities. During the second year of the pandemic, 30.8% of people with disabilities delayed getting medical care and 28.9% forwent needed care. People with disabilities were also significantly more likely to delay and forgo medical care than people without disabilities. Attention must be drawn to the unmet needs of people with disabilities and efforts must be made to expand their access to health care.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership (CQL), Towson, Maryland, USA
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19
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Smith SR, Blauwet C, Wells TPE. Anti-ableist oncology care: ensuring equity for people with physical disabilities. Lancet Oncol 2023; 24:1168-1170. [PMID: 37922927 DOI: 10.1016/s1470-2045(23)00406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA.
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Lassiter JW, Campbell AL, Taliaferro AR, Zimmerman SP. Measuring Health Professionals' Skills and Self-Efficacy for Communicating with Individuals with Disabilities: Instrument Development and Validation. JOURNAL OF HEALTH COMMUNICATION 2023:1-10. [PMID: 37908167 DOI: 10.1080/10810730.2023.2275125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Individuals with disabilities experience numerous health disparities compared to their non-disabled peers and face inequities associated with challenges accessing care, stigma, and bias. Health professionals have the opportunity to address health inequities through improved communication, a primary barrier to receiving quality care; however more training is needed. There are limitations to existing tools to measure the skills or self-efficacy of professionals to communicate with individuals with disabilities, and to assess the effectiveness of training programs. The purpose of this study was to develop and validate an instrument to measure health professionals' communication skills and self-efficacy specifically related to working with individuals with disabilities. After a comprehensive review of literature, expert review of proposed scale items, and pilot test, a 19-item survey was administered to 237 healthcare and health and physical education professionals. Construct validity was evaluated by performing an exploratory factor analysis on each subscale and Cronbach's alpha coefficient was used to measure internal consistency. For the skills subscale, Cronbach's α = .919 and for the self-efficacy subscale Cronbach's α = .949 after the removal of one item, resulting in a final 18-item inventory that demonstrates strong validity and reliability.
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Affiliation(s)
- Jill W Lassiter
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Amanada L Campbell
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Andrea R Taliaferro
- Department of Educational and Developmental Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Shannon P Zimmerman
- School of Sport Sciences, West Virginia University, Morgantown, West Virginia, USA
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21
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Youn GM, Shah JP, Wei EX, Alyono JC. Perceptions of Respect Among Patients With Hearing Loss in the United States. Otolaryngol Head Neck Surg 2023; 169:1086-1089. [PMID: 36994933 DOI: 10.1002/ohn.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023]
Abstract
Hearing loss is a common condition that can lead to disability and significantly impact the quality of life. However, as the literature investigating the relationship between hearing loss and patients' perception of respect within the clinical setting is lacking, we performed a retrospective, cross-sectional analysis of the 2017 National Health Interview Survey to elucidate this interaction. After weights were applied, 16,295,495 patients (mean age: 63.79, standard error: 0.28) with hearing loss were identified. Multivariable logistic regression analyses found that those with self-reported hearing loss were less likely to report being treated with respect by their healthcare providers (odds ratio [OR], 0.766; [95% confidence interval, CI: 0.691-0.848]) and less likely to be asked about their beliefs/opinions about the care that they received (OR, 0.842; [95% CI: 0.774-0.916]), indicating a possible disparity in care. Further investigation is needed to examine how this patient population is treated and how providers can create a more inclusive environment.
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Affiliation(s)
- Gun Min Youn
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jay P Shah
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer C Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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22
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Friedman C. Explicit and implicit: Ableism of disability professionals. Disabil Health J 2023; 16:101482. [PMID: 37271640 DOI: 10.1016/j.dhjo.2023.101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND People who work with disabled people or whose work is about disability - disability professionals - often have direct power over disabled people and can impact their lives immensely; they also have a role in creating and institutionalizing knowledge about disability. OBJECTIVE The aim of this study was to examine the explicit (conscious) and implicit (unconscious) disability attitudes of disability professionals. METHODS Between October 2021 and February 2023, disability professionals (n = 417) completed the Symbolic Ableism Scale (SAS) and the Disability Attitudes Implicit Association Test (DA-IAT). We had the following research questions: (1.) What are disability professionals' explicit attitudes towards disability? (2.) What are disability professionals' implicit attitudes towards disability? (3.) What is the relationship between disability professionals' explicit and implicit disability attitudes? and (4.) What sociodemographic factors correlate with disability professionals' explicit and implicit disability attitudes? We examined these questions using descriptive statistics, t-tests, a two-dimensional model of prejudice, and linear regression models. RESULTS In our sample, 77.24% of disability professionals preferred nondisabled people explicitly and 82.03% implicitly. Most commonly, disability professionals were symbolic ableists (37.8%). Race, political orientation, and job type correlated with disability professionals' explicit attitudes, while disability, gender, and job type correlated with their implicit attitudes. CONCLUSIONS Ableism cannot be eradicated until disability professionals look inward and rid themselves of negative attitudes; until that occurs, disability professionals will continue to do a disservice to the very people they have dedicated their careers to - disabled people.
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Affiliation(s)
- Carli Friedman
- CQL | the Council on Quality and Leadership, 100 West Road, Suite 300, Towson, MD 21204, USA.
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23
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Yanes T, Nathan V, Wallingford C, Faragher R, Nankervis K, Jacobs C, Vassos M, Boyle F, Carroll A, Smith S, McInerney-Leo A. Australasian genetic counselors' attitudes toward disability and prenatal testing: Findings from a cross-sectional survey. J Genet Couns 2023. [PMID: 37735951 DOI: 10.1002/jgc4.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
Diagnostic genetic testing and non-invasive prenatal testing (NIPT) for conditions associated with disability are becoming increasingly available to consumers. This genetic information can be used in the disability setting to inform factors such as prognosis, management, and reproductive decision-making. Genetic counselors (GCs) play an important role in the provision of genetic testing and NIPT, and their attitudes toward disability can influence how genetic information is communicated and shape patients' responses. This study aimed to evaluate and describe Australasian GCs' experience with and attitudes toward disabilities to identify potential biases and training needs. A cross-sectional survey was distributed to 400 GCs registered with the Human Genetics Society of Australasia. Of the 106 respondents (participation rate: 26%), a significantly greater proportion were more comfortable interacting with individuals with physical disability as compared to intellectual disability (p < 0.001). GCs with personal experiences with disabilities reported significantly greater comfort interacting with people with intellectual disability than those without experience (p = 0.012). Qualitative analysis revealed discomfort was less reflective of bias than inexperience and apprehension about communicating disrespectfully. GCs believed people with disabilities experience discrimination and that having a disability could make a person stronger, wiser, and more motivated. Most GCs viewed prenatal testing for disabilities positively as it allowed for decisions regarding continuing the pregnancy and/or provided opportunity to prepare. Challenges identified for prenatal counseling included negative societal attitudes and the low visibility of disability. GCs felt that 'personal beliefs' was the primary factor influencing the decision to terminate a pregnancy affected by disability. These findings highlight important education and training needs for GCs to improve preparedness and comfort when communicating with people with a disability.
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Affiliation(s)
- Tatiane Yanes
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Vaishnavi Nathan
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Courtney Wallingford
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Rhonda Faragher
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Nankervis
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Maria Vassos
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Fran Boyle
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
| | - Annemaree Carroll
- School of Education, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Smith
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for the Digital Child, The University of Queensland, Brisbane, Queensland, Australia
| | - Aideen McInerney-Leo
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
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24
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Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6569. [PMID: 37623155 PMCID: PMC10454622 DOI: 10.3390/ijerph20166569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.
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Affiliation(s)
- Ursula Meidert
- School of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (G.D.); (T.B.); (F.W.); (A.G.-G.)
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25
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Schwab SM, Silva PL. Intellectual Humility: How Recognizing the Fallibility of Our Beliefs and Owning Our Limits May Create a Better Relationship Between the Physical Therapy Profession and Disability. Phys Ther 2023; 103:pzad056. [PMID: 37265361 DOI: 10.1093/ptj/pzad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
Despite the many advancements over the history of the profession, physical therapy remains in a somewhat paradoxical relationship with disability. The physical therapist profession values disability as diversity but continues to focus on the normalization of body functions as the primary means to promote functionality in people with disability. This focus, consistent with a medicalized view of disability, may prevent physical therapists from empowering individuals with disability to explore alternative, yet effective, perceptual-motor strategies to achieve their functional goals. Additionally, recent research documents implicit, negative biases of physical therapists and physical therapist assistants toward people with disability, again consistent with the medicalized view that disability is the product of an imperfectly functioning body. Dominant underlying beliefs in any profession are often difficult to counter because they are so pervasive, and those beliefs can be reinforced and made stronger when challenged. The purpose of this Perspective article is to introduce physical therapists to a rising construct in psychology-intellectual humility-that may help to facilitate the profession's relationship with disability. Intellectual humility is predicated on recognizing the fallibility of one's beliefs and related practices. Intellectual humility is a promising construct for physical therapy to address the disability paradox and confront implicit attitudes that have served as the basis for many dominant ideas about disability. This Perspective synthesizes views and evidence from the behavioral and social sciences, philosophy, and critical disability studies to contribute to the ongoing evolution of the profession with respect to disability. IMPACT The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.
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Affiliation(s)
- Sarah M Schwab
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Paula L Silva
- Department of Psychology, Center for Cognition, Action, & Perception, University of Cincinnati, Cincinnati, Ohio, USA
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26
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Ennis JS, Riggan KA, Nguyen NV, Kramer DB, Smith AK, Sulmasy DP, Tilburt JC, Wolf SM, DeMartino ES. Triage Procedures for Critical Care Resource Allocation During Scarcity. JAMA Netw Open 2023; 6:e2329688. [PMID: 37642967 PMCID: PMC10466166 DOI: 10.1001/jamanetworkopen.2023.29688] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023] Open
Abstract
Importance During the COVID-19 pandemic, many US states issued or revised pandemic preparedness plans guiding allocation of critical care resources during crises. State plans vary in the factors used to triage patients and have faced criticism from advocacy groups due to the potential for discrimination. Objective To analyze the role of comorbidities and long-term prognosis in state triage procedures. Design, Setting, and Participants This cross-sectional study used data gathered from parallel internet searches for state-endorsed pandemic preparedness plans for the 50 US states, District of Columbia, and Puerto Rico (hereafter referred to as states), which were conducted between November 25, 2021, and June 16, 2023. Plans available on June 16, 2023, that provided step-by-step instructions for triaging critically ill patients were categorized for use of comorbidities and prognostication. Main Outcomes and Measures Prevalence and contents of lists of comorbidities and their stated function in triage and instructions to predict duration of postdischarge survival. Results Overall, 32 state-promulgated pandemic preparedness plans included triage procedures specific enough to guide triage in clinical practice. Twenty of these (63%) included lists of comorbidities that excluded (11 of 20 [55%]) or deprioritized (8 of 20 [40%]) patients during triage; one state's list was formulated to resolve ties between patients with equal triage scores. Most states with triage procedures (21 of 32 [66%]) considered predicted survival beyond hospital discharge. These states proposed different prognostic time horizons; 15 of 21 (71%) were numeric (ranging from 6 months to 5 years after hospital discharge), with the remaining 6 (29%) using descriptive terms, such as long-term. Conclusions and Relevance In this cross-sectional study of state-promulgated critical care triage policies, most plans restricted access to scarce critical care resources for patients with listed comorbidities and/or for patients with less-than-average expected postdischarge survival. This analysis raises concerns about access to care during a public health crisis for populations with high burdens of chronic illness, such as individuals with disabilities and minoritized racial and ethnic groups.
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Affiliation(s)
- Jackson S. Ennis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | - Kirsten A. Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Center for Bioethics, Boston, Massachusetts
| | - Alexander K. Smith
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Daniel P. Sulmasy
- Departments of Medicine and Philosophy, Georgetown University, Washington, DC
- Kennedy Institute of Ethics, Georgetown University, Washington, DC
| | - Jon C. Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Susan M. Wolf
- University of Minnesota Medical School, Minneapolis
- University of Minnesota Law School, Minneapolis
| | - Erin S. DeMartino
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
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Qin E, Seeds A, Wallingford A, Copley M, Humbert A, Junn C, Starosta A. Transmission of Bias in the Medical Record Among Physical Medicine and Rehabilitation Trainees. Am J Phys Med Rehabil 2023; 102:e106-e111. [PMID: 36757856 DOI: 10.1097/phm.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ABSTRACT Stigmatizing language can negatively influence providers' attitudes and care toward patients, but this has not been studied among physiatrists. An online survey was created to assess whether stigmatizing language can impact physical medicine and rehabilitation trainees' attitudes toward patients. We hypothesized stigmatizing language would negatively impact trainees' attitudes. Participants were randomized to a stigmatizing or neutral language vignette describing the same hypothetical spinal cord injury patient. Questions were asked about attitudes and assumptions toward the patient, pain management based on the vignette, and general views regarding individuals with disabilities. Between August 2021 and January 2022, 75 US physical medicine and rehabilitation residency trainees participated. Thirty-seven (49.3%) identified as women; 52 (69.3%) were White, and half (50.6%) received the stigmatized vignette. Participants exposed to stigmatizing language scored 4.8 points lower ( P < 0.01) on the provider attitude toward patient scale compared with those exposed to neutral language. There were no significant differences in the disability attitude scores between the two groups ( P = 0.81). These findings may indicate that stigmatizing language in the medical record may negatively affect physical medicine and rehabilitation trainees' attitudes toward patients. Further exploration is needed to identify the best way to educate trainees and reduce the propagation of bias in the medical record.
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Affiliation(s)
- Evelyn Qin
- From the Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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28
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Yenmez NN. Addressing neurodiversity in nursing education. J Prof Nurs 2023; 47:A1-A2. [PMID: 37295919 DOI: 10.1016/j.profnurs.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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29
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Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
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Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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Clarke KEN, Hong K, Schoonveld M, Greenspan AI, Montgomery M, Thierry JM. Severity of Coronavirus Disease 2019 Hospitalization Outcomes and Patient Disposition Differ by Disability Status and Disability Type. Clin Infect Dis 2023; 76:871-880. [PMID: 36259559 PMCID: PMC9620763 DOI: 10.1093/cid/ciac826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Systemic inequities may place people with disabilities at higher risk of severe coronavirus disease 2019 (COVID-19) illness or lower likelihood to be discharged home after hospitalization. We examined whether severity of COVID-19 hospitalization outcomes and disposition differ by disability status and disability type. METHODS In a retrospective analysis of April 2020-November 2021 hospital-based administrative data among 745 375 people hospitalized with COVID-19 from 866 US hospitals, people with disabilities (n = 120 360) were identified via ICD-10-CM codes. Outcomes compared by disability status included intensive care admission, invasive mechanical ventilation (IMV), in-hospital mortality, 30-day readmission, length of stay, and disposition (discharge to home, long-term care facility (LTCF), or skilled nursing facility (SNF). RESULTS People with disabilities had increased risks of IMV (adjusted risk ratio [aRR]: 1.05; 95% confidence interval [CI]: 1.03-1.08) and in-hospital mortality (1.04; 1.02-1.06) compared to those with no disability; risks were higher among people with intellectual and developmental disabilities (IDD) (IMV [1.34; 1.28-1.40], mortality [1.31; 1.26-1.37]), or mobility disabilities (IMV [1.13; 1.09-1.16], mortality [1.04; 1.01-1.07]). Risk of readmission was increased among people with any disability (1.23; 1.20-1.27) and each disability type. Risks of discharge to a LTCF (1.45, 1.39-1.51) or SNF (1.78, 1.74-1.81) were increased among community-dwelling people with each disability type. CONCLUSIONS Severity of COVID-19 hospitalization outcomes vary by disability status and type; IDD and mobility disabilities were associated with higher risks of severe outcomes. Disparities such as differences in discharge disposition by disability status require further study, which would be facilitated by standardized data on disability. Increased readmission across disability types indicates a need to improve discharge planning and support services.
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Affiliation(s)
- Kristie E N Clarke
- Center for Surveillance, Epidemiology, and Laboratory Services, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kai Hong
- Center for Surveillance, Epidemiology, and Laboratory Services, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan Schoonveld
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,ORISE Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Arlene I Greenspan
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martha Montgomery
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - JoAnn M Thierry
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wolf L, Delao A, Perhats C, Valdez A, Strout T, Clark P, Moon M, Frisch S, Callihan M. The Experiences of United States Emergency Nurses Related to Witnessed and Experienced Bias: A Mixed-Methods Study. J Emerg Nurs 2023; 49:175-197. [PMID: 36528419 DOI: 10.1016/j.jen.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to obtain a broad view of the knowledge, attitudes, beliefs, and lived experiences of emergency nurses regarding implicit and explicit bias. METHODS An exploratory, descriptive, sequential mixed-methods approach using online surveys and focus groups to generate study data. Two validated instruments were incorporated into the survey to evaluate experiences of microaggression in the workplace and ethnocultural empathy. Focus group data were collected using Zoom meetings. RESULTS The final sample comprised 1140 participants in the survey arm and 23 focus group participants. Significant differences were found in reported experiences of institutional, structural, and personal microaggressions for non-white vs white participants. Respondents who identified Christianity as their religious group had lower mean scores on items representing empathetic awareness. Respondents who identified as nonheterosexual had significantly higher mean total Scale of Ethnocultural Empathy scores, empathetic awareness subscale scores, and empathetic feeling and expression subscale scores. Thematic categories that arose from the focus group data included witnessed bias, experienced bias, responses to bias, impact of bias on care, and solutions. DISCUSSION In both our survey and focus group data, we see evidence that racism and other forms of bias are threats to safe patient care. We challenge all emergency nurses and institutions to reflect on the implicit and explicit biases they hold and to engage in purposeful learning about the effects of individual and structural bias on patients and colleagues. We suggest an approach that favors structural analysis, intervention, and accountability.
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Evans W, Lisiecka D, Farrell D. Exploring the impact educational interventions have on nursing and medical students' attitudes and empathy levels towards people with disability. A systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231155781. [PMID: 36798039 DOI: 10.1177/17446295231155781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This systematic review aimed to explore the impact educational interventions have on undergraduate nursing and medical students' attitudes and empathy levels towards people with disability. There are over one billion people with some form of disability currently. A growing body of research reveals that nurses and doctors display negative attitudes including decreased empathy towards people with disability. A systematic review using narrative synthesis of chosen randomized controlled trials was employed. A comprehensive search was completed in June 2021 on six databases (CINAHL, Medline, Science Direct, Health Research Premium - PROQUEST, Scopus. Cochrane Library). The search strategy yielded 21,616 studies and only three randomised controlled trials fulfilled the eligibility criteria. These trials included 125 participants (n = 50 medical students and n = 75 nursing students) and evaluated the effectiveness of a disabled health course, disability education module with bedside teaching and wheelchair workshop intervention. Findings from one study revealed that a disabled health course using affective learning method based on a transformative learning theory significantly improves attitudes to disability amongst nursing students however there was no statistically significant difference in empathy levels. More high-quality randomised controlled trials with greater theoretical and methodological complexity are needed to identify more effective educational approaches that enhance attitude and empathy levels of these key stakeholders.
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Affiliation(s)
- William Evans
- 8813Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Munster Technology University Tralee, Ireland
| | | | - Dawn Farrell
- 8813Munster Technology University Kerry, Tralee, Ireland
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Radtke HB, Berger A, Skelton T, Goetsch Weisman A. Neurofibromatosis Type 1 (NF1): Addressing the Transition from Pediatric to Adult Care. Pediatric Health Med Ther 2023; 14:19-32. [PMID: 36798587 PMCID: PMC9925753 DOI: 10.2147/phmt.s362679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Health care transition, or HCT, is the process of adolescents and young adults moving from a child/family-centered model of health care to an adult/patient-centered model of health care. Healthcare providers have an essential role in this process which can be especially challenging for individuals with medical or special healthcare needs. Neurofibromatosis type 1 (NF1) is a complex multisystem disorder requiring lifelong medical surveillance, education, and psychosocial support. This review highlights the transition needs of NF1 patients and provides resources for both clinicians and families to facilitate HCT in this population. The authors propose a framework for the development of an effective NF1 transition program by using the Six Core Elements model of the Got Transition program, reviewing existing literature, and incorporating author experiences in the care and transition of NF1 patients.
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Affiliation(s)
- Heather B Radtke
- Medical College of Wisconsin, Milwaukee, WI, USA,Children’s Tumor Foundation, New York, NY, USA,Correspondence: Heather B Radtke, Email
| | - Angela Berger
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Tammi Skelton
- UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Allison Goetsch Weisman
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA,Northwestern University, Chicago, IL, USA
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Ahmed MK, Scretching D, Lane SD. Study designs, measures and indexes used in studying the structural racism as a social determinant of health in high income countries from 2000-2022: evidence from a scoping review. Int J Equity Health 2023; 22:4. [PMID: 36609274 PMCID: PMC9817325 DOI: 10.1186/s12939-022-01796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, structural racism has been well documented as an important social determinant of health (SODH) resulting in racial inequality related to health. Although studies on structural racism have increased over the years, the selection of appropriate designs, measures, and indexes of measurement that respond to SODH has not been comprehensively documented. Therefore, the lack of evidence seems to exist. This scoping review was conducted to map and summarize global evidence on the use of various designs, measures, and indexes of measurement when studying structural racism as a social determinant of health. METHODS We performed a scoping review of global evidence from 2000 to 2022 published in 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Web of Science, ProQuest, and relevant grey literature on structural racism. We conducted a systematic search using keywords and subject headings around 3 concepts. We included peer reviewed original research/review articles which conceived the framework of social determinants of health (SODH) and studied structural racism. RESULTS Our review identified 1793 bibliographic citations for screening and 54 articles for final review. Articles reported 19 types of study design, 87 measures of exposure and 58 measures of health outcomes related to structural racism. 73 indexes or scales of measurement were used to assess health impacts of structural racism. Majority of articles were primary research (n = 43/54 articles; 79.6%), used quantitative research method (n = 32/54 articles; 59.3%) and predominantly conducted in the United States (n = 46/54 articles; 85.2.6%). Cross-sectional study design was the most used design (n = 17/54 articles; 31.5%) followed by systematic review (n = 7/54 articles; 13.0%) and narrative review (n = 6/54 articles; 11.1%). Housing and residential segregation was the largest cluster of exposure with the highest impact in infant health outcome. CONCLUSIONS Our review found several key gaps and research priorities on structural racism such as lack of longitudinal studies and availability of structural or ecological data, lack of consensus on the use of consolidated appropriate measures, indexes of measurement and appropriate study designs that can capture complex interactions of exposure and outcomes related to structural racism holistically.
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Affiliation(s)
- Md Koushik Ahmed
- grid.264484.80000 0001 2189 1568Department of Public Health, Falk College of Sports and Human Dynamics, Syracuse University, 150 Crouse Dr, 430 White Hall, Syracuse, NY 13244 USA
| | - Desiree Scretching
- grid.264484.80000 0001 2189 1568School of Information Studies, Syracuse University, 343 Hinds Hall, Syracuse, NY 13244 USA
| | - Sandra D. Lane
- grid.264484.80000 0001 2189 1568Department of Public Health, Falk College of Sports and Human Dynamics, 439 White Hall, Syracuse University, Syracuse, NY 13244 USA
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Howick J, Palipana D, Dambha-Miller H, Khunti K. Turning diversity from a barrier to a facilitator of empathy in health care. Br J Gen Pract 2023; 73:24-25. [PMID: 36543548 PMCID: PMC9799349 DOI: 10.3399/bjgp23x731613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jeremy Howick
- Jeremy is the Director of the Stoneygate Centre for Excellence in Empathic Healthcare at the University of Leicester and author of a bestselling book: Doctor You: Revealing the Science of Self-healing @jeremyhowick
| | - Dinesh Palipana
- Dinesh Palipana is an emergency doctor, a lawyer, and was Australia's Person of the Year in 2021
| | - Hajira Dambha-Miller
- Hajira Dambha-Miller is an NIHR Clinical Lecturer at the University of Southampton and a GP. @HDambhaMiller
| | - Kamlesh Khunti
- Kamlesh Khunti, CBE, is Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester. @kamleshkhunti
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Derbyshire DW, Spencer AE, Grosskopf B, Blackmore T. The importance of disability representation to address implicit bias in the workplace. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1048432. [PMID: 37033196 PMCID: PMC10073421 DOI: 10.3389/fresc.2023.1048432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023]
Abstract
Introduction People are disabled by barriers in society, not by their impairment. Barriers can be physical or be caused by people's implicit and explicit attitudes towards people with disabilities. Methods We utilise the Implicit Association Test to investigate implicit attitudes towards people with disabilities among Human Resource professionals and people involved in making hiring decisions. Results We find no significant differences between people who work for large companies or Small- to Medium-sized Enterprises. Similarly, working in Human Resources (or making recruitment decisions) has no effect on implicit bias. We supply the first evidence linking a person's own health status (measured using EQ-5D-5L) to their implicit bias. We find that a worse health status is associated with lower implicit bias towards people with disabilities. In addition, we find women have lower implicit bias than men. Discussion The discussion reflects on the need for greater disability representation within the workplace - especially in making hiring decisions.
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Affiliation(s)
- Daniel W. Derbyshire
- European Centre for Environment and Human Health, University of Exeter, Exeter, United Kingdom
- Correspondence: Daniel Derbyshire
| | - Anne E. Spencer
- Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Brit Grosskopf
- Department of Economics, University of Exeter, Exeter, United Kingdom
| | - Theo Blackmore
- disAbility Cornwall and Isles of Scilly, Truro, United Kingdom
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Cunningham GB, Cunningham HR. Bias among managers: Its prevalence across a decade and comparison across occupations. Front Psychol 2022; 13:1034712. [PMID: 36438417 PMCID: PMC9692076 DOI: 10.3389/fpsyg.2022.1034712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/26/2022] [Indexed: 11/03/2023] Open
Abstract
Employees from minoritized and subjugated groups have poorer work experiences and fewer opportunities for advancement than do their peers. Biases among decision makers likely contributes to these patterns. The purposes of this study were to (a) examine the explicit biases and implicit biases among people in management occupations (e.g., chief executives, operations managers, advertising and promotions managers, financial managers, and distributions managers, among others) and (b) compare their biases with people in 22 other occupations. The authors analyzed responses from visitors to the Project Implicit website, including assessments of their racial, gender, disability, and sexual orientation biases from 2012 to 2021. Results indicate that managers expressed moderate levels of explicit and implicit bias across all dimensions. Managers differed from people in other occupations in roughly one-third of the comparisons. The biggest differences came in their implicit biases, with managers expressing more bias than people in other occupations. The study's originality rests in the scope of the work (the authors analyzed data from over 5 million visitors representing 23 broad occupations); comparison of people in management occupations to those in other work settings; and empirically demonstrating the biases that managers have.
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Affiliation(s)
- George B. Cunningham
- Laboratory for Diversity in Sport, Department of Sport Management, University of Florida, Gainesville, FL, United States
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Reiner G. What COVID-19 Can Teach Nurses About Liability Risks. Am J Nurs 2022; 122:32-38. [PMID: 36201381 DOI: 10.1097/01.naj.0000892496.89368.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Georgia Reiner
- Georgia Reiner is a risk analyst with Aon Affinity Healthcare Division, Fort Washington, PA. Contact author: . The author and planners have disclosed no potential conflicts of interest, financial or otherwise
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Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood) 2022; 41:1371-1378. [PMID: 36190880 PMCID: PMC10359967 DOI: 10.1377/hlthaff.2022.00413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
For almost fifty years, federal civil rights laws such as Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, and Section 1557 and other provisions of the 2010 Patient Protection and Affordable Care Act have prohibited discrimination against Americans with disabilities, including in health care. Despite these laws, disabled Americans continue to experience disparities in health and health care, from preventive care to home and community-based services. In its 2022 Health Equity Framework for People with Disabilities, the National Council on Disability highlighted some of these disparities and recommended remedies. To explore these concerns, this article examines disability inequities and potential solutions within six areas. It concludes by recommending the ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community.
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Affiliation(s)
- Lisa I. Iezzoni
- Lisa I. Iezzoni , Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
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Lagu T, Haywood C, Reimold K, DeJong C, Sterling RW, Iezzoni LI. 'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities. Health Aff (Millwood) 2022; 41:1387-1395. [PMID: 36190896 PMCID: PMC9984238 DOI: 10.1377/hlthaff.2022.00475] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians' bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.
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Affiliation(s)
- Tara Lagu
- Tara Lagu , Northwestern University, Chicago, Illinois
| | | | | | | | | | - Lisa I. Iezzoni
- Harvard University and Massachusetts General Hospital, Boston, Massachusetts
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Lund EM, Ayers KB. Ever-changing but always constant: "Waves" of disability discrimination during the COVID-19 pandemic in the United States. Disabil Health J 2022; 15:101374. [PMID: 36156274 PMCID: PMC9436863 DOI: 10.1016/j.dhjo.2022.101374] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
The ongoing novel coronavirus 2019 (COVID-19) pandemic has had considerable effects on the disability community. As the pandemic has progressed and changed, the manifestations of these effects have differed, and yet the underlying causes-ableism including the devaluation of disabled lives-have remained consistent. In this commentary, we explore the impact of the pandemic on the disability community in the United States, conceptualizing four distinct but overlapping "waves" of discrimination: 1) healthcare rationing and missed opportunities for disability inclusion, 2) access to resources, supplies, and accommodations; 3) vaccine access; and 4) long COVID and disability identity. Throughout our discussion of these waves, we detail the discrimination faced by people with disabilities, the underlying ableism that perpetuates it, and the resilience shown by the disability community. We end with a call for combating systemic ableism in healthcare and public health systems.
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Affiliation(s)
- Emily M Lund
- Department of Educational Studies in Psychology, Research Methodology and Counseling, University of Alabama, USA.
| | - Kara B Ayers
- Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, University of Cincinnati College of Medicine, Department of Pediatrics, USA
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Feldner HA, Evans HD, Chamblin K, Ellis LM, Harniss MK, Lee D, Woiak J. Infusing disability equity within rehabilitation education and practice: A qualitative study of lived experiences of ableism, allyship, and healthcare partnership. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:947592. [PMID: 36188899 PMCID: PMC9397845 DOI: 10.3389/fresc.2022.947592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022]
Abstract
Background Addressing issues of diversity, equity, and inclusion (DEI) has become central in implementing inclusive and socially responsible rehabilitation education and clinical practice. Yet, the constructs of disability and d/Deaf identity and culture, as well as ableism and allyship are often overlooked. Or, these concepts are approached using outdated philosophical perspectives that pathologize disability and fail to prioritize the lived experiences, expertise, intersectionality, and self-identified needs of people with disabilities. A Critical Disability Studies (CDS) framework may provide a background for better understanding and responding to these issues through allyship. Purpose This study employed a CDS framework to understand the lived experiences of ableism and allyship from faculty, staff, and students on University of Washington (UW) campuses who identify as d/Deaf, disabled/with a disability, or as having a chronic health condition. Methods During 2020–2021, we conducted in-depth, semi-structured interviews and focus groups with 22 diverse undergraduate and graduate students, faculty, and staff with disabilities, one third who also identified as people of color. Encounters were audio-recorded, transcribed verbatim, and coded using constant comparison until themes emerged. Results Four major themes that emerged from the data are: (1) Ever-present ableism in healthcare, (2) Ableism at the intersections, (3) COVID: Surfacing ableism and expanding access, and (4) Disability allyship and healthcare partnership building. Experiences of ableism and allyship were identified at individual, group/unit, and institutional/systemic levels, though participants reported significantly fewer instances of allyship compared to experiences of ableism. Participants identified intersections between disability and other marginalized identities and juxtaposed the benefits of widespread adoption of many access-increasing practices and technologies due to the COVID-19 pandemic, while also highlighting ways in which the pandemic created new obstacles to inclusion. Conclusions This analysis provides insights into ways of implementing inclusive practices in rehabilitation education, practice, and beyond. Rehabilitation students, faculty, and staff may not be aware of how ableism affects their disabled peers or underpins their professional education. It is important to cultivate opportunities within professional education and clinical training to explicitly address our collective role in creating inclusive and accessible academic and healthcare experiences for our diverse community post COVID-19. Drawing on a CDS framework, the research team devised the mnemonic TRAC, which includes Training, Recognition and Representation, Attendance and Action, and Calling to account as strategic guidelines for operationalizing such opportunities.
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Affiliation(s)
- Heather A. Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
- Center for Research and Education on Accessible Technology and Experiences (CREATE), University of Washington, Seattle, WA, United States
- *Correspondence: Heather A. Feldner
| | - Heather D. Evans
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Katherine Chamblin
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Lesley M. Ellis
- The Disability and Deaf Cultural Center, University of Washington, Seattle, WA, United States
| | - Mark K. Harniss
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Disability Studies Program, University of Washington, Seattle, WA, United States
| | - Joanne Woiak
- Disability Studies Program, University of Washington, Seattle, WA, United States
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Guidry-Grimes L. Disability bioethics and the commitment to equality. THEORETICAL MEDICINE AND BIOETHICS 2022; 43:209-220. [PMID: 35986153 PMCID: PMC9391207 DOI: 10.1007/s11017-022-09575-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
Robert Veatch's The Foundations of Justice: Why the Retarded and the Rest of Us Have Claims to Equality (1986) delves into deep questions of justice through the case of a child with disabilities. I describe what is basically right about this vision, as well as what is problematic from the standpoint of contemporary disability bioethics. From there, I dive into the notion of vulnerability that is at play in his work. He describes disability as necessarily a condition of weakness, lesser-than existence, and neediness. When disability is viewed in this way as an inherently vulnerable state of being, the essential sociopolitical dimensions of disability receive inadequate attention, which, in turn, makes it impossible to identify injustices correctly. I connect these points to concrete challenges faced by disability communities during the COVID-19 pandemic, which have raised profound questions about the just use of scarce critical care resources. Any case drawn from the pandemic is a very different kind of case than that of the child in Veatch's book, but a commonality is the question of who should get what limited resources when needs and urgency vary.
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Khouderchah C, Eijansantos E, Bindman J, Henson L. Impact of a 10-week disability elective on health professions students' attitudes towards disabled persons. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:773-778. [PMID: 35809908 DOI: 10.1016/j.cptl.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/25/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Disability is overlooked in health provider training despite the growing number of patients and providers with a disability. In-depth training on delivering outstanding care is provided as part of training for health professions, however little guidance is provided on how to interact with patients with disabilities. EDUCATIONAL ACTIVITY AND SETTING Students enrolled in a 10-week interdisciplinary elective at the University of California, San Francisco were asked to participate in the study. Students who consented to participate completed a pre-intervention assessment that incorporated the Interaction with Disabled Persons Scale (IDP) and Marlowe-Crowne Social Desirability Scale Short Form C (MC). At the conclusion of the elective, participating students retook both surveys as part of a post-intervention assessment. FINDINGS There was a significant difference in IDP score and non-significant difference in MC score following the elective. There was a positive but non-significant correlation between the paired results for the IDP and MC surveys. SUMMARY Following completion of a 10-week disability awareness curriculum, there was a significant improvement in health professions students' perceptions towards persons with disabilities.
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Affiliation(s)
- Christy Khouderchah
- 1st-year Pharmacy Resident, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States.
| | - Emily Eijansantos
- 4th-year Medical Student, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Jay Bindman
- 4th-year Medical Student, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Laurence Henson
- Resident Physician, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States.
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Smeltzer SC, Tina Maldonado L, McKeever A, Amorim F, Arcamone A, Nthenge S. Qualitative Descriptive Study of Childbirth Educators' Perspectives on Prenatal Education for Women With Physical Disability. J Obstet Gynecol Neonatal Nurs 2022; 51:302-312. [PMID: 35331670 DOI: 10.1016/j.jogn.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability. DESIGN Qualitative descriptive design. SETTING Telephone interviews. PARTICIPANTS Seventeen childbirth educators. METHODS We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis. RESULTS We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability. CONCLUSION Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.
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Schultz KR, Mona LR, Cameron RP. Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:131-139. [PMID: 35502271 PMCID: PMC9046713 DOI: 10.1007/s40141-022-00349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 10/25/2022]
Abstract
Purpose of Review Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns. Recent Findings While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life. Summary Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.
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Affiliation(s)
- Katlin R Schultz
- VA Long Beach Healthcare System, SCI/D Service (07/128) 5901 E 7th Street, Long Beach, CA 90822 USA
| | - Linda R Mona
- VA Long Beach Healthcare System, SCI/D Service (07/128) 5901 E 7th Street, Long Beach, CA 90822 USA
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Aguillard K, Hughes R, Gemeinhardt GL, Schick V, McCurdy S. "They Didn't Ask." Rural Women With Disabilities and Experiences of Violence Describe Interactions With the Healthcare System. QUALITATIVE HEALTH RESEARCH 2022; 32:656-669. [PMID: 34978225 DOI: 10.1177/10497323211059142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Women with disabilities are at risk of experiencing multiple forms of severe and prolonged violence, yet guidelines for screening this population are unclear, screening rates are historically low, and screening tools may be inadequate to capture disability-related aspects of abuse. We conducted qualitative in-depth interviews with 33 rural women in the United States with diverse disabilities and experiences of violence. They described overarching healthcare provider and system factors that influenced their trust and confidence in healthcare delivery as an avenue to support their safety. Women described interactions with the healthcare system during their experience of violence as a missed opportunity for identifying and responding to their abuse and connecting them with resources. We conclude with policy and practice recommendations based on women with disabilities' perspectives and insights.
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Affiliation(s)
| | | | | | - Vanessa Schick
- 12340University of Texas School of Public Health, Houston, TX, USA
| | - Sheryl McCurdy
- 12340University of Texas School of Public Health, Houston, TX, USA
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Parey B, Sinanan L. Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad. QUALITATIVE HEALTH RESEARCH 2022; 32:479-490. [PMID: 34893008 DOI: 10.1177/10497323211059151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Even though easily accessible and cost-effective healthcare is a fundamental human right, many persons with disabilities experience healthcare barriers and poor health outcomes. We explore the healthcare barriers among working-age persons with disabilities in Trinidad using a qualitative descriptive approach. Semi-structured interviews with 26 participants reveal barriers at the personal, healthcare facility, and societal levels. The findings indicate the need for a nation-wide integrated digitalized system and increased intersectoral collaborations to support adequate healthcare among persons with disabilities in Trinidad. Increased consultation with persons with disabilities and transformation of the disability discourses within the healthcare system and at the national level are also recommended as part of the humanisation of their care.
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Affiliation(s)
- Bephyer Parey
- Sir Arthur Lewis Institute of Social and Economic Studies, 37612The University of the West Indies, St. Augustine, Trinidad and Tobago
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Feldner HA, VanPuymbrouck L, Friedman C. Explicit and implicit disability attitudes of occupational and physical therapy assistants. Disabil Health J 2021; 15:101217. [PMID: 34629321 DOI: 10.1016/j.dhjo.2021.101217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/10/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reduction of explicit and implicit bias in healthcare providers is a critical issue faced by our society in moving toward more equitable and culturally appropriate health and rehabilitation care. Because resources for OT and PT services are limited and shortages in these professions exist, direct care provision by occupational and physical therapist assistants (OTA/PTA) is on the rise and valued in comprehensive rehabilitation practice. It is important to consider attitudes and biases of OTA/PTA, as they are directly involved in provision of rehabilitation services for people with disabilities. OBJECTIVE This study examined the explicit and implicit disability attitudes of a large cross-section of OTA/PTA. METHODS Secondary data analysis was completed using data from 6113 OTA/PTA from the Project Implicit Disability Attitudes Implicit Association Test. Implicit attitudes were calculated and OTA/PTA explicit and implicit disability attitudes were compared. Results were further categorized using an adapted version of Son Hing et al.'s two-dimensional model of prejudice. RESULTS Findings revealed the majority of OTA/PTA reported having no explicit preference for people with disabilities or nondisabled people. However, the majority of OTA/PTA were aversive ableists, indicating low explicit and high implicit bias. CONCLUSIONS Though explicit bias is lower in OTA/PTA, implicit bias is strong, indicating that people with disabilities face bias that may influence clinical interactions, and may be reproduced in professional education, practice, and policy. Concrete action must be taken to recognize and address disability bias to reduce health disparities in people with disabilities.
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Affiliation(s)
- Heather A Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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Lingras KA, Alexander ME, Vrieze DM. Diversity, Equity, and Inclusion Efforts at a Departmental Level: Building a Committee as a Vehicle for Advancing Progress. J Clin Psychol Med Settings 2021:10.1007/s10880-021-09809-w. [PMID: 34529234 PMCID: PMC8444514 DOI: 10.1007/s10880-021-09809-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
Academic Health Centers (AHCs) across the nation are experiencing a reawakening to the importance of Diversity, Equity, and Inclusion (DEI). Such work impacts both employees and patients served by healthcare institutions. Yet, for departments without previously existing formal channels for this work, it is not always apparent where to begin. The current manuscript details a process for creating a committee as a vehicle for championing DEI efforts at the department level within an AHC. The authors present a six-step model for forming a DEI Committee and progress monitoring measures to remain accountable to identified objectives. In each step, the authors provide examples of their work with the goal for readers to tailor and apply each step to their own departments’ DEI efforts. The current paper also identifies lessons learned with regard to barriers and facilitators of department-level DEI work. Reflections and next steps for DEI work beyond the proposed model are also discussed.
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Affiliation(s)
- Katherine A Lingras
- Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Ave., 2A West, Minneapolis, MN, 55454, USA.
| | | | - Danielle M Vrieze
- Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Ave., 2A West, Minneapolis, MN, 55454, USA
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