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Genetic counselors' implicit racial attitudes and their relationship to communication.

ABSTRACT: Implicit racial attitudes are thought to shape interpersonal interactions and may contribute to health-care disparities. This study explored the relationship between genetic counselors' implicit racial attitudes and their communication during simulated genetic counseling sessions.A nationally representative sample of genetic counselors completed a web-based survey that included the Race Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998; Cooper et al., 2012). A subset of these counselors (n = 67) had participated in an earlier study in which they were video recorded counseling Black, Hispanic, and non-Hispanic White SCs about their prenatal or cancer risks. The counselors' IAT scores were related to their session communications through robust regression modeling.Genetic counselors showed a moderate to strong pro-White bias on the Race IAT (M = 0.41, SD = 0.35). Counselors with stronger pro-White bias were rated as displaying lower levels of positive affect (p < .05) and tended to use less emotionally responsive communication (p < .10) when counseling minority SCs. When counseling White SCs, pro-White bias was associated with lower levels of verbal dominance during sessions (p < .10). Stronger pro-White bias was also associated with more positive ratings of counselors' nonverbal effectiveness by White SCs.Implicit racial bias is associated with negative markers of communication in minority client sessions and may contribute to racial disparities in processes of care related to genetic services.

SUBMITTER: Schaa KL

PROVIDER: S-EPMC4945109 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Genetic counselors' implicit racial attitudes and their relationship to communication.

Schaa Kendra L KL Roter Debra L DL Biesecker Barbara B BB Cooper Lisa A LA Erby Lori H LH

Health psychology : official journal of the Division of Health Psychology, American Psychological Association 20150201 2

<h4>Objective</h4>Implicit racial attitudes are thought to shape interpersonal interactions and may contribute to health-care disparities. This study explored the relationship between genetic counselors' implicit racial attitudes and their communication during simulated genetic counseling sessions.<h4>Method</h4>A nationally representative sample of genetic counselors completed a web-based survey that included the Race Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998; Cooper e ...[more]

PMID: 25622081

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Project description:Research has shown that patient experiences and outcomes of genetic counseling are not equitable across racial categories, disadvantaging Black patients relative to White patients. One major factor contributing to such racial disparities might be genetic counselor racial bias. The present study examined the prevalence of and variation in racial bias toward Black (vs. White) Americans among genetic counselors in North America. This study extends the current literature of racial disparities in experiences and outcomes of genetic counseling by distinguishing prejudice (negative feelings or attitudes) and stereotyping (beliefs) at the implicit and explicit levels as well as by including both certified genetic counselors and genetic counseling trainees. Two-hundred and fifteen genetic counselors (107 genetic counselors Board-certified by the American Board of Genetic Counseling, 108 genetic counseling trainees from Accreditation Council for Genetic Counseling accredited programs) completed four measures in a random order: the Race Implicit Association Test (IAT, for implicit prejudice), feeling thermometer (for explicit prejudice), the Medical Cooperativeness IAT (for implicit stereotyping), and a self-report measure of explicit stereotypes (for explicit stereotyping). On average, genetic counselors (both certified genetic counselors and genetic counseling trainees) were slightly to moderately in favor of White Americans over Black Americans at the implicit level. They were also slightly more likely to associate "medically cooperative" stereotypes with White Americans more than Black Americans implicitly. In contrast, genetic counselors, on average, did not display either explicit prejudice or explicit negative stereotyping, which may reflect social desirability concerns among genetic counselors. However, genetic counselors as a group strongly endorsed stereotypes related to mistrust (mistrustful of the healthcare system, skeptical of genetic testing, mistrustful of genetic counselors) to be more true for Black (vs. White) Americans. Finally, our study revealed relatively large variability in each type of bias across genetic counselors. Future research should examine how such variability in each type of bias is associated with patient experiences and outcomes of genetic counseling.

Project description:Previous research using immersive virtual reality (VR) has shown that after a short period of embodiment by White people in a Black virtual body, their implicit racial bias against Black people diminishes. Here we tested the effects of some socio-cognitive variables that could contribute to enhancing or reducing the implicit racial bias. The first aim of the study was to assess the beneficial effects of cooperation within a VR scenario, the second aim was to provide preliminary testing of the hypothesis that empathy and political attitudes could contribute to implicit bias about race, while the third aim was to explore the relationship between political attitudes and empathy. We had (Caucasian) participants embodied in a Black virtual body and engaged either in a cooperative (Coop group) or in a non-cooperative (Neutral group) activity with a confederate experimenter embodying another Black avatar. Before and after VR, we measured participants' implicit racial bias by means of Implicit Association Test (IAT) and their perceived closeness toward the confederate experimenter. Before VR we also assessed participants' political attitudes and empathy traits. Results revealed that, as compared to the Neutral group, the Coop group showed lower IAT scores after the social interaction. Interestingly, in the Neutral but not the Coop group the perceived closeness toward the confederate experimenter was associated with the initial racial bias: the more the participants reduced their distance, the more they reduced their IAT score. Moreover, reported traits of empathy and political attitudes significantly explained the variance observed in the initial implicit bias, with perspective-taking, empathic concern, and personal distress being significant predictors of the IAT scores. Finally, there was a relationship between political attitudes and empathy: the more participants considered themselves as left-wing voters, the higher their perspective-taking and empathic concern scores. We discuss these findings within the neuroscientific and social cognition field and encourage scholars from different domains to further explore whether and under which conditions a given manipulation for reducing racial bias could be efficiently transposed in VR.

Project description:Research shows religiosity and spirituality (R/S) influence genetic counseling patients' and families' risk perception, decision-making, and coping. No published studies have examined how genetic counselors respond to patient-initiated R/S statements. This exploratory study examined genetic counselors' response types and reasons for their responses to two prenatal patient's R/S statements. Genetic counselors (n = 225) recruited through a National Society of Genetic Counselors eblast completed a survey containing two hypothetical scenarios regarding a prenatal patient's receipt of a trisomy 18 diagnosis. Scenarios were identical except for the last patient statement: "God makes everything possible…we leave things in his hands" (a deferring statement) or "I feel like God is punishing me for something I did" (an attributing statement). Imagining they were the counselor, participants wrote a response to each scenario and provided reasons for their response. Responses were analyzed using the Helping Skills Verbal Response System. MANOVA and chi-square tests, examining differences in response type based on patient statement (deferring or attributing), participant comfort with R/S, and years of experience, yielded a significant multivariate effect for scenario (p < 0.001). Responses to the deferring statement scenario contained a greater proportion of content statements (p < 0.001), closed questions (p < 0.001), and information-giving (p < 0.001). Responses to the attributing statement scenario contained a greater proportion of open questions (p = 0.05), influencing statements (p < 0.001), and affective statements (p = 0.006). Neither comfort with R/S nor genetic counseling experience significantly affected response type. Thematic analysis of reasons for responses yielded nine themes. Most prevalent were exploration (of the patient's statement), validation, correction (of patient's beliefs), and reassurance. The findings reflect stylistic differences in how and why genetic counselors respond to patients.

Dataset Information

Genetic counselors' implicit racial attitudes and their relationship to communication.

Publications

Genetic counselors' implicit racial attitudes and their relationship to communication.

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