Mindfulness practice: A promising approach to reducing the effects of clinician implicit bias on patients

Patient Education and Counseling

Volumn 100, Issue 2, 2017, Pages 372-376

  Burgess, Diana J ^a,b   Beach, Mary Catherine ^c   Saha, Somnath ^d,e  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b UNIVERSITY OF MINNESOTA MEDICAL SCHOOL   (United States)

^c JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^d PORTLAND VA MEDICAL CENTER   (United States)

^e OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

Author keywords

Attitude of health personnel; Burnout; Compassion; Compassion fatigue; Disparities; Medical education; Meditation; Mindfulness; Physician patient relations

Indexed keywords

ATTENTION; ATTENTIONAL CONTROL; BEHAVIOR; BURNOUT; CLINICIAN IMPLICIT BIAS; COMPASSION; COMPASSION FATIGUE; DOCTOR PATIENT RELATION; EGALITARIAN VALUE; EMOTION; EMPATHY; EVIDENCE BASED PRACTICE; HEALTH CARE CONCEPTS; HEALTH CARE DISPARITY; INTERPERSONAL COMMUNICATION; LOVINGKINDNESS MEDITATION; MEDICAL PRACTICE; MEDITATION; MINDFULNESS; NEUROIMAGING; NOTE; PATIENT CARE STRESS; PATIENT CENTERED COMMUNICATION; PERSONALIZED MEDICINE; RACISM; STAFF TRAINING; STRESS; WELLBEING; ETHNOLOGY; HEALTH CARE PERSONNEL; HEALTH PERSONNEL ATTITUDE; HUMAN; PREJUDICE; PSYCHOLOGY; STATISTICAL BIAS;

ATTITUDE OF HEALTH PERSONNEL; BIAS; BURNOUT, PROFESSIONAL; COMPASSION FATIGUE; EMOTIONS; EMPATHY; HEALTH PERSONNEL; HEALTHCARE DISPARITIES; HUMANS; MEDITATION; MINDFULNESS; PREJUDICE; RACISM;

EID: 84994493999     PISSN: 07383991     EISSN: 18735134     Source Type: Journal    
DOI: 10.1016/j.pec.2016.09.005     Document Type: Note

References (74)

1. [1] Zestcott, C.A., Blair, I.V., Stone, J., Examining the presence, consequences, and reduction of implicit bias in health care: a narrative review. Group Process. Intergr. Relat. 19:4 (2016), 528–542 Epub 2016 May 22.
2. [2] Paradies, Y., Truong, M., Priest, N., A systematic review of the extent and measurement of healthcare provider racism. J. Gen. Intern. Med. 29:February (2) (2014), 364–387.
3. [3] Sabin, J.A., Riskind, R.G., Nosek, B.A., Health care providers’ implicit and explicit attitudes toward lesbian women and gay men. Am. J. Public Health 105:9 (2015), 1831–1841.
4. [4] Hall, W.J., Chapman, M.V., Lee, K.M., et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am. J. Public Health 105:December (12) (2015), e60–76.
5. [5] Dovidio, J.F., Fiske, S.T., Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. Am. J. Public Health 102:May (5) (2012), 945–952.
6. [6] van Ryn, M., Burgess, D.J., Dovidio, J.F., et al. The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois Rev. Soc. Sci. Res. Race 8:01 (2011), 199–218.
7. [7] Burgess, D., van Ryn, M., Dovidio, J., Saha, S., Reducing racial bias among health care providers: lessons from social-cognitive psychology. J. Gen. Intern. Med. 22:June (6) (2007), 882–887.
8. [8] Dovidio, J.F., Gaertner, S.L., Aversive racism. Zanna, M.P., (eds.) Advances in Experimental Social Psychology, vol. 36, 2004, Academic Press, San Diego, CA, 1–51.
9. [9] Devine, P.G., Forscher, P.S., Austin, A.J., Cox, W.T., Long-term reduction in implicit race bias: a prejudice habit-breaking intervention. J. Exp. Soc. Psychol. 48:November (6) (2012), 1267–1278.
10. [10] Stone, J., Moskowitz, G.B., Non‐conscious bias in medical decision making: what can be done to reduce it?. Med. Educ. 45:8 (2011), 768–776.
11. [11] Schaa, K.L., Roter, D.L., Biesecker, B.B., Cooper, L.A., Erby, L.H., Genetic counselors’ implicit racial attitudes and their relationship to communication. Health Psychol., 34(2), 2015, 111.
12. [12] Richeson, J.A., Shelton, J.N., Brief report: thin slices of racial bias. J. Nonverbal Behav. 29:1 (2005), 75–86.
13. [13] Tang, Y.-Y., Hölzel, B.K., Posner, M.I., The neuroscience of mindfulness meditation. Nat. Rev. Neurosci. 16:4 (2015), 213–225.
14. [14] Bishop, S.R., Lau, M., Shapiro, S., et al. Mindfulness: a proposed operational definition. Clin. Psychol. Sci. Pract. 11:3 (2004), 230–241.
15. [15] Krasner, M.S., Epstein, R.M., Beckman, H., et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 302:September (12) (2009), 1284–1293.
16. [16] Lamothe, M., Rondeau, É., Malboeuf-Hurtubise, C., Duval, M., Sultan, S., Outcomes of MBSR or MBSR-based interventions in health care providers: a systematic review with a focus on empathy and emotional competencies. Complement. Ther. Med. 24 (2016), 19–28.
17. [17] Creswell, J.D., Mindfulness interventions. Annual Review of Psychology, 2016.
18. [18] Boellinghaus, I., Jones, F.W., Hutton, J., The role of mindfulness and loving-kindness meditation in cultivating self-compassion and other-focused concern in health care professionals. Mindfulness 5:2 (2014), 129–138.
19. [19] Greenwald, A.G., Poehlman, T.A., Uhlmann, E.L., Banaji, M.R., Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. J. Pers. Soc. Psychol. 97:July (1) (2009), 17–41.
20. [20] Kang, Y., Gray, J.R., Dovidio, J.F., The nondiscriminating heart: lovingkindness meditation training decreases implicit intergroup bias. J. Exp. Psychol. Gen., 143(3), 2014, 1306.
21. [21] Stell, A.J., Farsides, T., Brief loving-kindness meditation reduces racial bias, mediated by positive other-regarding emotions. Motiv. Emotion, 2015, 1–8.
22. [22] Parks, S., Birtel, M.D., Crisp, R.J., Evidence that a brief meditation exercise can reduce prejudice toward homeless people. Soc. Psychol. 45:6 (2014), 458–465.
23. [23] Lueke, A., Gibson, B., Mindfulness meditation reduces implicit age and race bias the role of reduced automaticity of responding. Soc. Psychol. Pers. Sci. 6:3 (2015), 284–291.
24. [24] Lueke, A., Gibson, B., Brief mindfulness meditation reduces discrimination. Psychol. Conscious. Theor. Res. Pract., 3(1), 2016, 34.
25. [25] Amodio, D.M., The neuroscience of prejudice and stereotyping. Nat. Rev. Neurosci. 15:October (10) (2014), 670–682.
26. [26] Phelps, E.A., O'Connor, K.J., Cunningham, W.A., et al. Performance on indirect measures of race evaluation predicts amygdala activation. J. Cogn. Neurosci. 12:September (5) (2000), 729–738.
27. [27] Teper, R., Segal, Z.V., Inzlicht, M., Inside the mindful mind how mindfulness enhances emotion regulation through improvements in executive control. Curr. Dir. Psychol. Sci. 22:6 (2013), 449–454.
28. [28] Irving, J.A., Park-Saltzman, J., Fitzpatrick, M., Dobkin, P.L., Chen, A., Hutchinson, T., Experiences of health care professionals enrolled in mindfulness-based medical practice: a grounded theory model. Mindfulness 5:1 (2014), 60–71.
29. [29] Moskowitz, G.B., On the control over stereotype activation and stereotype inhibition. Soc. Pers. Psychol. Compass 4:2 (2010), 140–158.
30. [30] Burgess, D.J., Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Med. Decis. Making(September (2)), 2009.
31. [31] Johnson, T.J., Hickey, R.W., Switzer, G.E., et al. The impact of cognitive stressors in the emergency department on physician implicit racial bias. Acad. Emerg. Med. 23:March (3) (2016), 297–305.
32. [32] Varkey, A.B., Manwell, L.B., Williams, E.S., et al. Separate and unequal: clinics where minority and nonminority patients receive primary care. Arch. Intern. Med. 169:February (3) (2009), 243–250.
33. [33] Regehr, C., Glancy, D., Pitts, A., LeBlanc, V.R., Interventions to reduce the consequences of stress in physicians: a review and meta-analysis. J. Nerv. Ment. Dis. 202:May (5) (2014), 353–359.
34. [34] Asuero, A.M., Queralto, J.M., Pujol-Ribera, E., Berenguera, A., Rodriguez-Blanco, T., Epstein, R.M., Effectiveness of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. J. Contin. Educ. Health Prof. 34:Winter (1) (2014), 4–12.
35. [35] Shapiro, S.L., Astin, J.A., Bishop, S.R., Cordova, M., Mindfulness-based stress reduction for health care professionals: results from a randomized trial. Int. J. Stress Manag., 12(2), 2005, 164.
36. [36] Dobkin, P.L., Bernardi, N.F., Bagnis, C.I., Enhancing clinicians’ well-being and patient-centered care through mindfulness. J. Contin. Educ. Health Prof. 36:Winter (1) (2016), 11–16.
37. [37] Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., Rakel, D., Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann. Fam. Med. 11:September–October (5) (2013), 412–420.
38. [38] Duchemin, A.M., Steinberg, B.A., Marks, D.R., Vanover, K., Klatt, M., A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary alpha-amylase levels. J. Occup. Environ. Med./Am. Coll. Occup. Environ. Med. 57:April (4) (2015), 393–399.
39. [39] Shapiro, S., Brown, K., Biegel, G., Self-care for health care professionals: effects of MBSR on mental well being of counseling psychology students. Train. Educ. Prof. Psychol. 1:2 (2007), 105–115.
40. [40] Todd, A.R., Bodenhausen, G.V., Richeson, J.A., Galinsky, A.D., Perspective taking combats automatic expressions of racial bias. J. Pers. Soc. Psychol., 100(6), 2011, 1027.
41. [41] Galinsky, A.D., Moskowitz, G.B., Perspective-taking: decreasing stereotype expression, stereotype accessibility, and in-group favoritism. J. Pers. Soc. Psychol. 78:April (4) (2000), 708–724.
42. [42] Todd, A.R., Galinsky, A.D., Bodenhausen, G.V., Perspective taking undermines stereotype maintenance processes: evidence from social memory, behavior explanation, and information solicitation. Soc. Cogn., 30(1), 2012, 94.
43. [43] Todd, A.R., Galinsky, A.D., Perspective–taking as a strategy for improving intergroup relations: evidence, mechanisms, and qualifications. Soc. Pers. Psychol. Compass 8:7 (2014), 374–387.
44. [44] Gutierrez, B., Kaatz, A., Chu, S., Ramirez, D., Samson-Samuel, C., Carnes, M., Fair play: a videogame designed to address implicit race bias through active perspective taking. Games Health J. 3:6 (2014), 371–378.
45. [45] Inzlicht, M., Gutsell, J.N., Legault, L., Mimicry reduces racial prejudice. J. Exp. Soc. Psychol. 48:1 (2012), 361–365.
46. [46] Wang, C.S., Kenneth, T., Ku, G., Galinsky, A.D., Perspective-taking increases willingness to engage in intergroup contact. PLoS One, 9(1), 2014, e85681.
47. [47] Mascaro, J.S., Darcher, A., Negi, L.T., Raison, C.L., The neural mediators of kindness-based meditation: a theoretical model. Front. Psychol., 6, 2015, 109.
48. [48] Shapiro, S.L., Schwartz, G.E., Bonner, G., Effects of mindfulness-based stress reduction on medical and premedical students. J. Behav. Med. 21:December (6) (1998), 581–599.
49. [49] Jazaieri, H., McGonigal, K., Jinpa, T., Doty, J.R., Gross, J.J., Goldin, P.R., A randomized controlled trial of compassion cultivation training: effects on mindfulness, affect, and emotion regulation. Motiv. Emotion 38:1 (2014), 23–35.
50. [50] Condon, P., Desbordes, G., Miller, W.B., DeSteno, D., Meditation increases compassionate responses to suffering. Psychol. Sci. 24:10 (2013), 2125–2127.
51. [51] Lim, D., Condon, P., DeSteno, D., Mindfulness compassion: an examination of mechanism and scalability. PLoS One, 10(2), 2015, e0118221.
52. [52] Hutcherson, C.A., Seppala, E.M., Gross, J.J., Loving-kindness meditation increases social connectedness. Emotion, 8(5), 2008, 720.
53. [53] Rosenberg, E.L., Zanesco, A.P., King, B.G., et al. Intensive meditation training influences emotional responses to suffering. Emotion, 15(6), 2015, 775.
54. [54] Weng, H.Y., Fox, A.S., Shackman, A.J., et al. Compassion training alters altruism and neural responses to suffering. Psychol. Sci. 24:7 (2013), 1171–1180.
55. [55] Penner, L.A., Blair, I.V., Albrecht, T.L., Dovidio, J.F., Reducing racial health care disparities a social psychological analysis. Policy Insights Behav. Brain Sci. 1:1 (2014), 204–212.
56. [56] Beach, M.C., Rosner, M., Cooper, L.A., Duggan, P.S., Shatzer, J., Can patient-centered attitudes reduce racial and ethnic disparities in care?. Acad. Med. J. Assoc. Am. Med. Coll. 82:February (2) (2007), 193–198.
57. [57] Beckman, H.B., Wendland, M., Mooney, C., et al. The impact of a program in mindful communication on primary care physicians. Acad. Med. J. Assoc. Am. Med. Coll. 87:June (6) (2012), 815–819.
58. [58] Beach, M.C., Roter, D., Korthuis, P.T., et al. A multicenter study of physician mindfulness and health care quality. Ann. Fam. Med. 11:September–October (5) (2013), 421–428.
59. [59] Teal, C.R., Shada, R.E., Gill, A.C., et al. When best intentions aren't enough: helping medical students develop strategies for managing bias about patients. J. Gen. Intern. Med. 25:Suppl. 2 (2010), S115–S118.
60. [60] Hernandez, R.A., Haidet, P., Gill, A.C., Teal, C.R., Fostering students’ reflection about bias in healthcare: cognitive dissonance and the role of personal and normative standards. Med. Teach. 35:April (4) (2013), e1082–1089.
61. [61] Gonzales, C.M., Kim, M.Y., Marantz, P.R., Implicit bias and its relation to health disparities: a teaching program and survey of medical students. Teach. Learn. Med. 26 (2014), 64–71.
62. [62] Anderson, J.R., Language, Memory, and Thought. 1976, Erlbaum, Hillsdale, NJ.
63. [63] Byrne, A., Tanesini, A., Instilling new habits: addressing implicit bias in healthcare professionals. Adv. Health Sci. Educ. 20:5 (2015), 1255–1262.
64. [64] Kang, Y., Gruber, J., Gray, J.R., Mindfulness and de-automatization. Emotion Rev. 5:2 (2013), 192–201.
65. [65] Devine, P.G., Monteith, M.J., Zuwerink, J.R., Elliot, A.J., Prejudice with and without compunction. J. Pers. Soc. Psychol. 60:June (6) (1991), 817–830.
66. [66] Malat, J., Clark-Hitt, R., Burgess, D.J., Friedemann-Sanchez, G., Van Ryn, M., White doctors and nurses on racial inequality in health care in the USA: whiteness and colour-blind racial ideology. Ethnic and racial studies 33:8 (2010), 1431–1450.
67. [67] Lowery, B.S., Knowles, E.D., Unzueta, M.M., Framing inequity safely: Whites’ motivated perceptions of racial privilege. Pers. Soc. Psychol. Bull. 33:September (9) (2007), 1237–1250.
68. [68] Dobkin, P.L., Hassed, C.S., Mindful Medical Practitioners. 2016, Springer International Publishing, Switzerland.
69. [69] Carmody, J., Baer, R.A., Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J. Behav. Med. 31:1 (2008), 23–33.
70. [70] Gauthier, T., Meyer, R.M., Grefe, D., Gold, J.I., An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot. J. Pediatr. Nurs. 30:March–April (2) (2015), 402–409.
71. [71] Kemper, K.J., Yun, J., Group online mindfulness training: proof of concept. J. Evid. Based Complement. Alternat. Med. 20:January (1) (2015), 73–75.
72. [72] Brady, S., O'Connor, N., Burgermeister, D., Hanson, P., The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspect. Psychiatr. Care 48:July (3) (2012), 129–137.
73. [73] Mackenzie, C.S., Poulin, P.A., Seidman-Carlson, R., A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Appl. Nurs. Res. 19:May (2) (2006), 105–109.
74. [74] Clarke, T.C., Black, L.I., Stussman, B.J., Barnes, P.M., Nahin, R.L., Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl. Health Stat. Rep. 79:February (10) (2015), 1–16.