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Found 233 results
  1. Content Article
    This report from the BME Leadership Network comprises examples of anti-racist initiatives from BME Leadership Network members, to help advance equality within the workforce and for service users.
  2. Content Article
    This research letter in JAMA Internal Medicine describes a multicentre retrospective cohort study that investigated associations between stigmatising language, errors in the diagnostic process and demographics for hospitalised patients. The study found that stigmatising language in patient documentation was associated with diagnostic error and multiple diagnostic process errors. The prevalence of stigmatising language was higher in documentation relating to Black patients and patients with housing instability. The authors argue that this may be indicative of clinician biases that interfere with data gathering, communication and clinical reasoning. They call for further research to explore the mechanisms behind this and to understand how clinician use of stigmatising language can be reduced.
  3. News Article
    Black and Asian people who spot cancer symptoms are taking twice as long to be diagnosed as white people, a shocking new study shows. Research by Bristol Myers Squibb (BMS) and Shine Cancer Support shows that people from minority ethnic backgrounds face an average of a year’s delay between first noticing symptoms and receiving a diagnosis of cancer. These groups report more negative experiences of cancer care than white people, limited knowledge about the diseases and lack of awareness of support services, which all contribute to later diagnostic rates. “In a year that’s revealed that the UK’s cancer survival lags behind comparable countries, I am saddened but unsurprised that people from minority ethnic groups face additional hurdles that delay their diagnosis.” said Ceinwen Giles, co-ceo of Shine Cancer Support. “We know that catching cancer earlier saves lives, yet with year long waits for some people, collaborative efforts between health leadership, advocacy groups and the pharmaceutical industry are required.” Read full story Source: The Independent, 9 April 2024
  4. Content Article
    Cancer Equals is a campaign launched by Bristol Myers Squibb, to understand and help address the many factors that lead to delays in cancer diagnosis and variations in cancer experiences between people from different backgrounds. Cancer Equals research shows that people from minority ethnic groups experience seven months longer delays between noticing cancer symptoms and diagnosis compared to white individuals. Many factors lead to these delays in diagnosis and differences in people’s experience of cancer – no one’s story is the same. Delays to diagnosis will and do impact prognosis, changing the course of peoples’ lives. Health disparities and inequalities are an ongoing and pressing issue, with the UK government, NHS and patient groups committed to increasing earlier diagnosis and improving outcomes for people living with cancer.
  5. News Article
    Black children in the UK are at four times greater risk of complications following emergency appendicitis surgery compared with white children. Researchers revealed these alarming disparities in postoperative outcomes recently. The study, led by Dr Amaki Sogbodjor, a consultant anaesthetist at Great Ormond Street Hospital and University College London, showed that black children faced these greater risks irrespective of their socioeconomic status and health history. Appendicitis is one of the most prevalent paediatric surgical emergencies; approximately 10,000 cases are treated annually in the UK. However, this marks the first attempt to scrutinise demographic variances in postoperative complication rates related to appendicitis. Dr Sogbodjor emphasised the critical need for further investigation into the root causes of these disparities. "This apparent health inequality requires urgent further investigation and development of interventions aimed at resolution," she said. Read full story Source: Surgery, 25 March 2024
  6. Content Article
    The use of patient portals to send messages to healthcare teams is increasing. This JAMA Network Open cross-sectional study of nearly 40,000 US patients aimed to find out whether there are differences in how care teams respond to messages from Asian, Black and Hispanic patients compared with similar White patients. The authors found that messages asking for medical advice sent by patients who belong to minoritised racial and ethnic groups were less likely to receive a response from doctors and more likely to receive a response from registered nurses. This suggests these patients receive lower prioritisation during triaging. The differences observed were similar among Asian, Black and Hispanic patients.
  7. Content Article
    This JAMA Network Open study aimed to explore whether standardised patients in a simulated environment can be effectively used to explore racial implicit bias and communication skills among doctors. For this cross-sectional study, 60 doctors were placed in an environment calibrated with cognitive stressors common to clinical environments. The results reflected expected communication patterns based on prior research (performed in actual clinical environments) on racial implicit bias and physician communication. The authors believe that this simulation and the process of its development can inform interventions that provide opportunities for skills development and assessment of skills in addressing racial implicit bias.
  8. News Article
    A secret report has warned that the NHS is failing to protect trainee paramedics from widespread sexual harassment and racism at work, The Independent has revealed. A confidential NHS England report uncovered by The Independent has found that “extremely alarming” conduct and undermining behaviour are rife in ambulance trusts across the country, with trainees subjected to derogatory comments about their age, ethnicity and appearance in front of patients. There is a “worrying acceptance” that this is “part of the job”, with students hesitant to raise complaints about sexual behaviour by male colleagues in case it gives them a reputation as “annoying snowflakes”, the report says. The revelations come after a recent NHS staff survey revealed that thousands of ambulance staff had reported unwanted sexual behaviour from colleagues and patients last year. One healthcare leader described the findings as “harrowing”, warning that much more needs to be done to protect junior staff. The national report, which is understood to have gone through several edited versions and is marked commercially sensitive, was not due to be released until The Independent obtained the document through a freedom of information request. It found an “undercurrent” of bullying in some areas, with examples of students leaving their jobs as a result of inappropriate behaviour. Trainees reported feeling undervalued and unwanted while on the job, with one apparently told: “Your concerns don’t matter – we have to meet patient demands.” Ambulance handover delays have also led to student paramedics having less experience and training on the job, prompting fears that newly qualified paramedics do not have sufficient levels of experience in life-critical situations. Read full story Source: The Independent, 19 March 2024
  9. News Article
    A board director has publicly criticised his trust for its treatment of Muslim staff and patients. Mohammed Hussain posted on social media that some board members at Bradford Teaching Hospitals “are not heard and listened to”, and that there is a “dissonance” between its espoused values and the “lived experiences” of minority ethnic staff. Mr Hussain, a non-executive director since 2019, was responding to a post by CEO Mel Pickup, who had said the trust had a “variety of support offers for colleagues observing Ramadan”. He said there are “many examples” of Muslim families experiencing poor responses to complaints to the trust, while claiming that “outstanding” Muslim staff are having to “move out of the area to progress because they are not promoted internally”. The trust said its launching an investigation into the concerns raised by Mr Hussain. Read full story (paywalled) Source: HSJ, 12 March 2024
  10. News Article
    Minority ethnic people, women and people from deprived communities are at risk of poorer healthcare because of biases within medical tools and devices, a report has revealed. Among other findings, the Equity in Medical Devices: Independent Review has raised concerns over devices that use artificial intelligence (AI), as well as those that measure oxygen levels. The team behind the review said urgent action was needed. Prof Frank Kee, the director of the centre for public health at Queen’s University Belfast and a co-author of the review, said: “We’d like an equity lens on the entire lifecycle of medical devices, from the initial testing, to recruitment of patients either in hospital or in the community, into the early phase studies and the implementation in the field after they are licensed,.” The government-commissioned review was set up by Sajid Javid in 2022 when he was health secretary after concerns were raised over the accuracy of pulse oximeter readings in Black and minority ethnic people. The widely used devices were thrown into the spotlight due to their importance in healthcare during the Covid pandemic, where low oxygen levels were an important sign of serious illness. The report has confirmed concerns pulse oximeters overestimate the amount of oxygen in the blood of people with dark skin, noting that while there was no evidence of this affecting care in the NHS, harm has been found in the US with such biases leading to delayed diagnosis and treatment, as well as worse organ function and death, in Black patients. The team members stress they are not calling for the devices to be avoided. Instead the review puts forward a number of measures to improve the use of pulse oximeters in people of different skin tones, including the need to look at changes in readings rather than single readings, while it also provides advice on how to develop and test new devices to ensure they work well for patients of all ethnicities. Read full story Source: The Guardian, 11 March 2024
  11. Content Article
    A core responsibility of the NHS is to maintain the highest standards of safety and effectiveness of medical devices available for all patients in its care. Evidence has emerged, however, about the potential for racial and ethnic bias in the design and use of some medical devices commonly used in the NHS, and that some ethnic groups may receive sub-optimal treatment as a result. In response to these concerns, the UK Government commissioned this independent review on equity in medical devices. In its final report, the Review sets out the need for immediate action to tackle the impact of ethnic biases in the use of medical devices. Its findings and recommendations have also been published in a short animation. The Government’s response to the Review's 18 recommendations has also been published alongside its final report.
  12. Content Article
    This report describes the findings of a study that collected stories of the working lives of Black and Brown healthcare staff during the Covid-19 pandemic. The study asked them to reflect on their experiences and highlight the changes they would like to see. It highlights a number of issues around victimisation, access to PPE, speaking up and risk assessments. The authors argue that the report confirms previous studies that identify the entrenched nature of racism in healthcare systems and highlights how systemic cultures of racism contributed to the disproportionate impact of Covid-19 on health and care workers from minority ethnic backgrounds.
  13. Content Article
    This US study looked at how critical care doctors approach shared decision-making with Black compared with White caregivers of critically ill patients. The authors found that racial disparities exist in critical care clinicians' approaches to shared decision-making and suggest potential areas for future interventions aimed at promoting equity.
  14. Content Article
    Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. Here we examine the key data on this complex and wide-ranging issue.
  15. Content Article
    This US study in the journal Pediatrics analysed a national sample of paediatric hospitalisations to identify disparities in safety events. The authors used data from the 2019 Kids’ Inpatient Database and looked at the independent variables of race, ethnicity and the organisation paying for care (for example, private insurance company or Medicaid). The results showed disparities in safety events for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in hospitals.
  16. Content Article
    Early-onset colon cancer (EOCC) is increasing in the US and disproportionately affects African-Americans. This analysis in the American Journal of Surgery aimed to compare EOCC survival among Black and White patients after matching relevant socio-demographic factors and stage. The authors found that Black patients with stage 3 EOCC are less likely to receive chemotherapy and have worse survival than White patients. They call for further research to identify potential factors driving this inequality.
  17. Content Article
    In this Lancet article, Lioba Hirsch shares her experience of labour and birth as a Black woman. She describes dismissive behaviours and blaming comments from several healthcare professionals that left her feeling unable to ask questions and advocate for herself and her baby. She suggests that the lack of compassion and dignity she was shown are a risk to patient safety: "I am so glad that my child was safe that day, but many children and their birthing parents are not and the slope from disrespect and disregard to dismissal and its consequences is a slippery one."
  18. News Article
    Black children in the UK are four times more likely to experience complications after appendicitis surgery than their white counterparts, a study has found. The study, funded by the Association of Paediatric Anaesthetists of Great Britain and Ireland, looked at 2,799 children from 80 hospitals across the UK aged under 16 who had surgery for suspected appendicitis between November 2019 and January 2022. Of these, 185 children (7%) developed postoperative complications within 30 days of the surgery. Three-quarters of these complications were related to the wound, while a quarter were respiratory, urinary or catheter-related or of unknown origin. The study found that black children had a four times greater risk of experiencing complications after the operation, and that this risk was independent of the child’s socioeconomic status and health history. Appendicitis is one of the most common paediatric surgical emergency with 10,000 performed every year. The authors said that this was the first study to look at the demographic differences of postoperative complication rates in regards to appendicitis. The researchers said they could not draw firm conclusions regarding why black children had worse outcomes after this type of emergency surgery, and that this apparent health inequality “requires urgent further investigation and development of interventions aimed at resolution”. Read full story Source: The Guardian, 22 February 2024
  19. Content Article
    This report aims to understand the NHS response to racism, what trusts and healthcare organisations do about it and how effective they are at addressing it. It brings together key learning from a number of significant tribunal cases and responses from 1,327 people to a survey about their experiences of raising allegations of racism within their organisations.
  20. Content Article
    This study assessed for disparities in the presentation and management of medullary thyroid cancer (MTC). The authors identified patients with MTC from the National Cancer Database and assessed differences in disease presentation and likelihood of guideline-concordant surgical management by sex and race/ethnicity. The results showed that male and non-White patients with MTC more frequently present with advanced disease, and Black patients are less likely to undergo guideline-concordant surgery.
  21. News Article
    The NHS Race and Health Observatory, in partnership with the Institute for Healthcare Improvement and supported by the Health Foundation, has established an innovative 15-month, peer-to-peer Learning and Action Network to address the gaps seen in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups. Across England, nine NHS Trusts and Integrated Care Systems will participate in this action oriented, fast-paced Learning and Action Network to improve outcomes in maternal and neonatal health. Through the Network, the nine sites will aim to address the gaps seen in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups. Haemorrhage, preterm birth, post-partum depression and gestational diabetes have been identified as some of the priority areas for the programme. The sites will generate tailored action plans with the aim of identifying interventions and approaches that reduce health inequalities and enhance anti-racism practices and learning from the programme. These will be evaluated and shared across and between healthcare systems. The Network, the first of its kind for the NHS, will combine Quality Improvement methods with explicit anti-racism principles to drive clinical transformation, and aims to enable system-wide change. Over a series of action, learning and coaching sessions, participants will review policies, processes and workforce metrics; share insights and case studies; and engage with mothers, parents, pregnant women and people. The programme will run until June 2025, supported by an advisory group from the NHS Race and Health Observatory, Institute for Healthcare Improvement, and experts in midwifery, maternal and neonatal medicine. Read full story Source: NHS Race and Health Observatory, 24 January 2024
  22. Content Article
    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Chidiebere is passionate about increasing representation of Black people in all forms of medical literature. In this interview, he explains how lack of representation at all levels of the healthcare system leads to disparities in healthcare experiences and outcomes. He outlines the importance of speaking openly about how racial bias affects patient safety, and argues that dispelling damaging myths about particular patient groups starts with equipping people with accurate health knowledge from a young age.
  23. News Article
    Deeply ingrained medical misogyny and racial biases are routinely putting people in need of treatment at risk, the government’s patient safety commissioner in England has warned. Dr Henrietta Hughes was appointed in 2022 in response to a series of scandals in women’s health. She outlined a “huge landscape” of biases in need of levelling, citing examples ranging from neonatal assessment tools and pulse oximeters that work less well for darker skin tones to heart valves, mesh implants and replacement hip joints that were not designed with female patients in mind. Hughes said: “I don’t see this as blaming individual healthcare professionals – doctors and nurses – for getting it wrong. It’s pervasive in the systems we have – the training, the experience, the resources. “Anatomy books are very narrow in their focus. Even the resuscitation models are of pale males – we don’t have female resuscitation models, we don’t have them in darker skin tones. This is deeply ingrained in the way that we assess and listen to patients.” She described the realisation that pulse oximeters, used to measure blood oxygen levels, work less well for darker skin tones as a “real shock to the system” when the problem was highlighted during the pandemic. More recently, the NHS Race and Health Observatory highlighted concerns about neonatal assessments. Bilirubinometers, widely used to assess jaundice in newborn babies, are less reliable for darker skin tones and some guidelines for the assessment of cyanosis (caused by a shortage of blood oxygen) refer to “pink”, “blue” or “pale” skin, without reference to skin changes in minority ethnic babies. The Apgar score, a quick test given to newborns that was rolled out in the 1950s, traditionally includes checking whether a baby is “pink all over”. “Even the names of those conditions – jaundice and cyanosis – suggest a colour. The Apgar score includes P for pink all over,” said Hughes. “There are systemic biases in that if you have a darker skin tone those conditions may not be so apparent.” Read full story Source: The Guardian, 4 February 2024
  24. Content Article
    Racial and ethnic disparities in health are substantial and persistent in the USA. They occur from the earliest years of life, are perpetuated by societal structures and systems, and profoundly affect children’s health throughout their lives. This series of articles in The Lancet Child & Adolescent Health summarises evidence on racial and ethnic inequities in the quality of paediatric care, outlines priorities for future research to better understand and address these inequities and discusses policy solutions to advance child health equity in the USA. Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence Policy solutions to eliminate racial and ethnic child health disparities in the USA
  25. Content Article
    Health care algorithms are used for diagnosis, treatment, prognosis, risk stratification and allocation of resources. However, bias in the development and use of algorithms can lead to worse outcomes for racial and ethnic minoritised groups and other historically marginalised populations such as individuals with lower incomes. This study aimed to provide a conceptual framework and guiding principles for mitigating and preventing bias in health care algorithms, in order to promote health and health care equity. The authors suggested five guiding principles: Promote health and health care equity during all phases of the health care algorithm life cycle Ensure health care algorithms and their use are transparent and explainable Authentically engage patients and communities during all phases of the health care algorithm life cycle and earn trustworthiness Explicitly identify health care algorithmic fairness issues and trade-offs Establish accountability for equity and fairness in outcomes from health care algorithms.
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