Implicit Bias in Health Care ___________________________________________________________________
EMPATHY INTERVENTIONS Promoting positive emotions such as empathy and compassion can help reduce implicit biases. This can involve strategies like perspective taking and role playing [77]. In a study examining analgesic prescription disparities, nurses were shown photos of White or African American patients exhibiting pain and were asked to recommend how much pain medication was needed; a control group was not shown photos. Those who were shown images of patients in pain displayed no differences in recommended dosage along racial lines; however, those who did not see the images averaged higher recommended dosages for White patients compared with Black patients [84]. This sug- gests that professionals’ level of empathy (enhanced by seeing the patient in pain) affected prescription recommendations. In a study of healthcare professionals randomly assigned to an empathy-inducing group or a control group, participants were given the IAT to measure implicit bias prior to and following the intervention. Level of implicit bias among participants in the empathy-inducing group decreased significantly compared with their control group counterparts [85]. INDIVIDUATION Individuation is an implicit bias reduction intervention that involves obtaining specific information about the individual and relying on personal characteristics instead of stereotypes of the group to which he or she belongs [4; 82]. The key is to concentrate on the person’s specific and unique experiences, achievements, personality traits, qualifications, and other personal attributes rather than focusing on gender, race, eth- nicity, age, ability, and other social attributes, all of which can activate implicit biases [118]. Teaching individuals to pause and take time to ask questions instead of relying on assumptions is vital [118]. When providers lack relevant information, they are more likely to fill in data with stereotypes, in some cases unconsciously. Time constraints and job stress increase the likelihood of this occurring [69]. MINDFULNESS Mindfulness requires stopping oneself and deliberately emptying one’s mind of distractions or allowing distractions to drift through one’s mind unimpeded, focusing only on the moment; judgment and assumptions are set aside. This approach involves regulating one’s emotions, responses, and attention to return to the present moment, which can reduce stress and anxiety [86]. There is evidence that mindfulness can help regulate biological and emotional responses and can have a positive effect on attention and habit formation [4]. A mind- fulness activity assists individuals to be more aware of their thoughts and sensations. This focus on deliberation moves the practitioner away from a reliance on instincts, which is the foundation of implicit bias-affected practice [4; 87]. Research indicates that there are two main types of mindfulness practice
[119]. The first is general mindful practice, which includes interventions that promote awareness to the individual in the present moment through current body sensation and emo- tional states. The second type is loving-kindness meditation, which entails individuals thinking of another person (from out-group or in-group) and sending love to them and to the self. The goal of this type of practice is to promote empathy and compassion to another person or persons. Mindfulness approaches include yoga, meditation, and guided imagery. Additional resources to encourage a mindfulness practice are provided later in this course. An approach to mindfulness using the acronym STOPP has been developed as a practical exercise to engage in mindfulness in any moment. STOPP is an acronym for [88]: • Stop • Take a breath
• Observe • Pull back • Practice
Visit the following website to view a short, animated video on the STOPP technique. After viewing the video, consider how you can incorporate the technique into your work. https://www.youtube.com/watch?v=tStXi7f7Vgk inter active activity Mindfulness practice has been explored as a technique to reduce activation or triggering of implicit bias, enhance aware- ness of and ability to control implicit biases that arise, and increase capacity for compassion and empathy toward patients by reducing stress, exhaustion, and compassion fatigue [89]. One study examined the effectiveness of a loving-kindness meditation practice training in improving implicit bias toward African Americans and unhoused persons. One hundred one non-Black adults were randomized to one of three groups: a six-week loving-kindness mindfulness practice, a six-week loving-kindness discussion, or the waitlist control. The IAT was used to measure implicit biases, and the results showed that the loving-kindness meditation practice decreased levels of implicit biases toward both groups [90]. There is also some novel evidence that mindfulness may have neurologic implications. For example, one study showed decreased amygdala activation after a mindfulness meditation [91]. However, additional studies are required in this area before conclusions can be reached.
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