Key result
Patient ethnicity and socioeconomic status do not alter clinician treatment recommendations in simulated cardiac arrest.
Why the study?
Correlational register data cannot determine whether ethnic and socioeconomic treatment differences after in-hospital cardiac arrest reflect true treatment bias or discrimination, necessitating experimental research.
Does patient ethnicity and socioeconomic status influence treatment recommendations by health care professionals in simulated in-hospital cardiac arrest?
RCT (n=238)
Randomized into experimental condition
Yes
Does patient ethnicity and socioeconomic status influence treatment recommendations by health care professionals in simulated in-hospital cardiac arrest?
Standardized Mean Difference: 0.09
Absolute Event Rate: 9.31% vs 9.61%
p-value: p=0.54
Health care professionals in Sweden did not exhibit treatment bias based on patient ethnicity or socioeconomic status in simulated in-hospital cardiac arrest scenarios, despite harboring some negative stereotypes.
Vignette study finds no ethnicity or SES bias in cardiac arrest recommendations; leaves open causes of real-world treatment disparities.
BACKGROUND: Research on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination - whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. OBJECTIVE: The primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals' (HCP) stereotypical beliefs about these groups. METHODS: HCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). RESULTS: No significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. CONCLUSIONS: Swedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.
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Agerström et al. (2023) conducted an RCT in In-hospital cardiac arrest (simulated cases) (n=238). Middle Eastern ethnicity and low socioeconomic status (simulated patient vignettes) vs. Swedish ethnicity and high socioeconomic status was evaluated on Treatment recommendation index score (range 0-15) (Cohen's d 0.09, p=0.54). Simulated in-hospital cardiac arrest patients received similar treatment recommendations from Swedish healthcare professionals regardless of Middle Eastern versus Swedish ethnicity or low versus high socioeconomic status.
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