title: Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directions.
abstract: BACKGROUND
  Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined.
  
  
  OBJECTIVE
  Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI.
  
  
  METHODS
  Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians.
  
  
  METHODS
  Four national SCI Model Systems sites.
  
  
  METHODS
  Individuals with SCI (N = 162) and their SCI physicians (N = 14).
  
  
  METHODS
  SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI.
  
  
  RESULTS
  Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = -4.54, 95% CI= -8.79, -0.28).
  
  
  CONCLUSIONS
  This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes.
authors.forename: Leslie R M
authors.initials: LR
authors.lastname: Hausmann
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
authors.forename: Christian
authors.initials: C
authors.lastname: Niyonkuru
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Oyster
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Burkitt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Shasha
authors.initials: S
authors.lastname: Gao
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D044383:Black People; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D063505:Racism; D013119:Spinal Cord Injuries / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D044465:White People
keywords: Racism; Social discrimination; Spinal cord injuries; Wheelchair