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What can we learn from social cognition research? Advancing inquiry into the causes of race/ethnicity disparities in treatment received. Michelle van Ryn, M.P.H., Ph.D. Associate Professor, Division of Epidemiology, University of Minnesota, Suite 300 1300 S. 2 nd Street

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slide1
What can we learn from social cognition research? Advancing inquiry into the causes of race/ethnicity disparities in treatment received

Michelle van Ryn, M.P.H., Ph.D.

Associate Professor, Division of Epidemiology,

University of Minnesota, Suite 300 1300 S. 2nd Street

Minneapolis, MN 55454-1015

Director, Colorectal Cancer Quality Enhancement Initiative and

Associate Director, Center for Chronic Disease Outcomes Research, Minneapolis VAMC

vanRyn@epi.umn.edu

background and problem
Background and Problem
  • There is a massive body of evidence documenting race/ethnicity disparities in medical care, independent of clinical appropriateness, payer, and treatment site.
  • There is empirical evidence for a provider contribution to race/ethnicity inequities in access to kidney transplant and cardiac procedures, quality of in-hospital care, psychiatric care, and pain control.
  • Research on the contribution of provider behavior to disparities in care is in its infancy.
theory and research driven inquiry
Theory and Research Driven Inquiry:
  • What factors may be influencing the clinical decision-making process so as to result in systematically different treatment by patient race/ethnicity?
  • What areas of inquiry can be drawn on to inform inquiry in this understudied area?
  • What existing bodies of research and theory will provide insight into understanding of the effect of patient demographic characteristics on clinical decision-making?
social cognition theory and research provides insight and a framework for inquiry
Social Cognition Theory and Research Provides Insight and a Framework For Inquiry.
  • Social cognition research and theory focuses on questions like...
    • How do we make sense of other people?
    • How do we develop our perceptions of others?
    • What factors influence the way we form beliefs about others?
    • How do we develop beliefs about reasons for their behavior (attributions)?
    • How do we make use of our “social knowledge” of others?
    • How do our beliefs about others influence our behavior?
slide5
There is considerable empirical evidence that:
  • Demographic (age, race/ethnicity, sex) and other characteristics (sickness, pre-maturity, diagnosis) can influence physician affect towards, opinions, beliefs and behaviors towards patients.
  • There is evidence that demographic characteristics influences the substantive content of encounters, including discussion of end-of-life care, advice to quit smoking, discussion of diet,exercise, mammography, prenatal preventive care advice regarding smoking cessation, alcohol use, and breastfeeding.
  • Provider behavior influences patient satisfaction, adherence, utilization, and outcomes .
slide6

Although understudied, there is some evidence that stereotyping (social cognition) is one mechanism through which provider treatment recommendations are influenced by patient race/ethnicity

  • Bogart and colleagues found that physicians were more likely to provide highly active antiretroviral therapy (HAART) to HIV/AIDS patients when they perceived them as likely to be adherent.
  • They then examined patient characteristics

associated with physician predictions of adherence by randomly assigning physicians to review patient vignettes that varied only on patient gender, disease severity, ethnicity, and risk group. African American patients were more likely to be rated as non-adherent independent of other factors.

slide7

Although understudied, there is some evidence that stereotyping (social cognition) is one mechanism through which provider treatment recommendations are influenced by patient race/ethnicity

  • van Ryn and colleagues found that physician ratings of patients' likelihood of having adequate social support and/or participating in cardiac rehabilitation as found to predict physicians' recommendations for revascularization, independent of clinical appropriateness for revascularization and other demographic characteristics.
  • In turn, this same group of physicians were more likely to rate African American patients as lacking in social support and unlikely to participate in cardiac rehabilitation than white patients.
primary hypotheses

Physician Beliefs

About Patient

(Beliefs about clinical factors, social and behavioral factors, resources. Includes conscious and unconsciously activated beliefs)

Primary Hypotheses:

Physician

Clinical

Decision-making (Diagnosis,Treatment Recommendation)

Patient

Race/ethnicity

Providers treatment recommendations are influenced by perceptions of patients’ social and behavioral characteristics, which in turn are affected by patient demographic characteristics.

slide10

Physician Beliefs

About Patient

(Beliefs about clinical factors, social and behavioral factors, resources. Includes conscious and unconsciously activated beliefs)

Provider Interpersonal Behavior

(e.g., participatory style, warmth, content, information giving, question-asking)

Patient

Race/ethnicity

  • An additional hypothesized mechanism through which provider behavior may influence race/ethnicity disparities and outcomes is through variation in communication and interpersonal behaviors, which in turn may affect quality of care and outcomes.
  • There is considerable evidence that patient socio-demographic characteristics can affect provider participatory style, level of psychosocial talk, close-ended question asking, warmth, information giving, and communication effectiveness.
stereotypes not just for bigots
Stereotypes: Not just for bigots
  • All humans share the cognitive strategy of making the world more manageable by using categorizing and generalizing techniques to simplify the massive amounts of complex information and stimuli to which they are exposed.
  • This generally adaptive process simplifies cognitive processing, reduces effort, and frees up cognitive resources.
  • In applying this process to the social world, people develop beliefs and expectations about categories or groups of people.
  • When individuals are mentally assigned to a particular class or group, the characteristics assigned to that group are unconsciously and automatically applied to the individual, a process referred to as stereotype application.
slide12
Stereotypes are social cognitions that contain our knowledge, beliefs, expectations, and feelings about a social group including:
  • Causal theories about how they obtained given characteristics.
  • Beliefs about degree of group variability.
  • Expectations about the traits, behaviors and circumstances likely for a given group or category.
  • Stereotypes may be connected to a feeling or elicit an emotional reaction (have an affective component).
stereotypes are efficient
Stereotypes are Efficient
  • Stereotypes, like all concepts, are mental representations of a category, or a class, of objects we believe belong together or hang together in some way. Apple, librarian, and cruise are all kinds concepts.
  • The use of stereotypes, like all concepts, is a efficient cognitive trick; concepts help us extract meaning from the huge amount of information that surrounds us.
  • Stereotypes allow us to automatically activate and apply a great deal of information without effort.
  • Think about what happens when you see an apple. What do you know about it without any conscious effort or thought? Do you “test” the degree to which this knowledge is true of each apple?
stereotyping can serve to meet deep human needs and motives
Stereotyping can serve to meet deep human needs and motives.
  • The need for belonging (to ones own group vs. out-group).
  • The need to promote self-esteem through downward social comparison (feel superior to others).
  • The need to justify existing social order, distribution of resource.
  • The need to believe in a just world.
i believe in equal rights and justice i treat all my clients patients the same
“I believe in equal rights and justice: I treat all my clients/patients the same”
  • Stereotype activation and application can be an automatic process
  • Stereotypes are often activated automatically (without intent).
  • Stereotypes can operate below conscious thought - individuals may not be aware of activation nor the impact on their perceptions, emotions and behavior.
  • Some studies found that stereotypes were activated more quickly than conscious cognition.
as a doctor i have to be a good judge of a patient s character
“As a doctor, I have to be a good judge of a patient's character.”
  • Social cognition research suggests that beliefs about, judgments, predictions and attributions for others' traits and behavior are frequently wrong
  • A massive body of communication, social interaction, and social cognition research has shown that it is common for people to apply...
    • Incorrect beliefs
    • Inaccurate theories
    • Inaccurate memories
    • Attributions errors (beliefs about causes or motives for others' behavior)
    • …to their interpretations of others and the social world.
if a person doesn t fit the group stereotype it will become clear during the encounter
“If a person doesn't fit the group stereotype it will become clear during the encounter.”
  • A large body of research shows that interactions tend to confirm our expectancies regardless of accuracy.
  • Identical behaviors is interpreted differently depending on race of performer (e.g. white “horseplay”; black “violence”).
  • There is ample evidence that people give different meaning to the same observed behavior depending on the race, class, or other characteristics of the person observed.
slide18

Provider-specific examples:

  • Mental health diagnoses varied among adolescents exhibiting the identical behavior based on prior labeling and race.
  • Medical students and Israeli providers assessment of normal toddlers children was negatively influenced by whether they were told the child had been born prematurely or not.
slide19

“The interpretive function of concepts lies at the heart of one of the central lessons of research in social cognition: When we observe our social world, we do not merely watch an objective reality unfold before our eyes. Rather, we, take part in shaping our own reality; the concepts we impose on events determine the meaning we extract from them.” Ziva Kunda

our interpretation of others behavior influences our behavior
Our interpretation of others' behavior influences our behavior.
  • Unconsciously activated stereotypes affect our behavior.
  • Our behavior toward others influences their behavior in turn (self-fulfilling prophecy).
self fulfilling prophesy
Self-fulfilling prophesy
  • Extensively studied in educational and job interviewing domains. Interviewers' interpersonal behaviors influenced by race of applicant, and in turn, interviewer behavior influences application behavior.
  • White students “primed” by subliminal images of African American men were more hostile in a word-guessing game with a white partner. This hostility then elicited more hostility from naïve white partner.
i assess and treat each patient individually so stereotyping isn t a problem
“I assess and treat each patient individually so stereotyping isn't a problem.”
  • Stereotypes are often applied in the presence of individuating information
  • If all we know about an individual is group category, we attribute characteristics of the group to the individual (serves a “base-rate” function).
  • Good news: Individuating information does replace stereotypical beliefs in many cases.
slide23
Many cognitive processes result in confirmation of expectancies (we process information in ways that support our preconceived ideas).
  • Individual information is understood and interpreted through the filter of generalized beliefs (stereotypes) about the person.
  • This phenomena is exacerbated when individuals' behavior is at all ambiguous, which is more likely in cross-cultural communication.
  • Stereotypes have been shown to influence predictions about others' likely future behavior even in the presence of instances of stereotype- inconsistent behavior.
factors that increase the likelihood of stereotype activation characterize physicians work
Factors that increase the likelihood of stereotype activation characterize physicians' work.
  • Individuals are more likely to activate and apply stereotypes when they are:
    • Tired
    • Distracted
    • Pressed for time
    • Anxious
  • These conditions may deplete the cognitive resources needed for processing individuating information and/or suppressing stereotypes.
slide26

Maybe not: We are often unconscious (no intention or awareness) of the way activated stereotypes affect our interpretation of another's behavior.

maybe not efforts at stereotype suppression can backfire
Maybe not: Efforts at Stereotype Suppression can Backfire
  • When experimental participants are asked to suppress stereotypes in arriving at judgments of an individual, they can do so.
  • However, initial suppression of stereotypes leads to increased activation and use in other settings encountered shortly thereafter.
maybe sometimes
Maybe sometimes:
  • There are individual and stimulus differences in automatic processing of stereotypes - those very low conscious prejudice less likely to automatically activate negative concepts/affect when stimulus is neutral, but equally likely when stimulus is negative.
maybe sometimes29
Maybe Sometimes:
  • Stereotype activation can be suppressed if it conflicts with other motives, such as boosting our feelings of self-worth.
  • If choices between alternate stereotypes and associated characteristics serves our interests, we will make that choice.
  • Desire to form rapid impressions increases stereotype activation and decreases attention to individuating information.
an ongoing major debate in social cognition literature

An Ongoing Major Debate in Social Cognition Literature:

How much control can we exert over automatic processes? Can we suppress unwanted stereotypes?

conclusions
Conclusions
  • There is an ample body of evidence supporting the hypothesis that patient socio-demographic characteristics can independently influence physician expectations, perceptions, affect and behavior toward patients.
  • Common misunderstandings about the nature of social cognition in combination with unrealistic expectations of physicians have served as a barrier to advancing research and policy in this area.
  • The lack of research in this area profoundly limits our ability to develop effective interventions.
slide32
This literature on providers’ perceptions of patients is in its infancy and varies widely in type and quality of method used.
  • We do not know the circumstances under which provider perceptions will or will not be influenced by patient characteristics,
  • Nor can we predict the specific perceptions that will be influenced or the exact implications of a set of perceptions for patient care.
  • NOTE: This presentation suggests a research agenda and a number of hypotheses to be tested rather than asserting proven causal relationships
selected challenges in research on the effect of social cognition on clinical decision making
Selected Challenges in Research on the Effect of Social Cognition on Clinical Decision-Making:
  • Frequently, R's must be blind to hypotheses.
  • Automatic or subconscious processes cannot be directly measured.
  • Unclear which specific beliefs/expectancies are relevant to treatment recommendations for a given illness.
  • Measures must occur in close temporal proximity to exposure (encounter, videotape, etc.)
  • Responses to videotapes inadequately capture actual encounters and processes, unknown generalizability.
slide34

Bibliography

Abreu JM. Conscious and nonconscious African American stereotypes: impact on first impression and diagnostic ratings by therapists. J Consult Clin Psychol 1999; 67(3):387-93.

American Medical Association. 2000. Ref Type: Internet Communication

Andersen SM, Klatzky RL, Murray J. Traits and social stereotypes: Efficiency differences in the social information processing. Journal of Personality and Social Psychology 1990; 59:192-201.

Anderson KO, Mendoza TR, Valero V, Richman SP, Russell C, Hurley J et al. Minority cancer patients and their providers: pain management attitudes and practice. Cancer 2000; 88(8):1929-38.

Armstrong K, Berlin M, Schwartz JS, Propert K, Ubel PA. Barriers to influenza immunization in a low-income urban population. Am J Prev Med 2001; 20(1):21-5.

Ayanian JZ, Cleary PD, Weissman JS, Epstein AM. The effect of patients' preferences on racial differences in access to renal transplantation [see comments]. N Engl J Med 1999; 341(22):1661-9.

Bain DJ. Doctor-patient communication in general practice consultations. Med Educ 1976; 10(2):125-31.

Bargh J, Chen M, Burrows L. Automaticity of Social Behavior. Journal of Personality and Social Psychology 1996; 71:230-244.

Bell PD, Hudson S. Equity in the diagnosis of chest pain: race and gender. Am J Health Behav 2001; 25(1):60-71.

Benson PR. Factors associated with antipsychotic drug prescribing by southern psychiatrists. Med Care 1983; 21(6):639-54.

Bertakis KD, Callahan EJ, Helms LJ, Azari R, Robbins JA, Miller J. Physician practice styles and patient outcomes: differences between family practice and general internal medicine. Med Care 1998; 36(6):879-91.

Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract 1991; 32(2):175-81.

slide35

Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract 1991; 32(2):175-81.

Bodenhausen GV, Kramer AM, Susser K. Happiness and stereotypic thinking in social judgement. Journal of Personality and Social Psychology 1994; 66:621-632.

Bodenhausen GV, Sheppard LA, Kramer GP. Negative affect and social judgement. European Journal of Social Psychology 1994; 24:45-62.

Bogart LM, Catz SL, Kelly JA, Benotsch EG. Factors influencing physicians' judgments of adherence and treatment decisions for patients with HIV disease. Med Decis Making 2001; 21(1):28-36.

Bogart LM, Kelly JA, Catz SL, Sosman JM. Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. J Acquir Immune Defic Syndr 2000; 23(5):396-404.

Borowsky SJ, Rubenstein LV, Meredith LS, Camp P, Jackson-Triche M, Wells KB. Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med 2000; 15(6):381-8.

Borum ML, Lynn J, Zhong Z. The effects of patient race on outcomes in seriously ill patients in SUPPORT: an overview of economic impact, medical intervention, and end-of-life decisions. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 2000; 48(5 Suppl):194-8.

Brenes GA, Paskett ED. Predictors of stage of adoption for colorectal cancer screening. Prev Med 2000; 31(4):410-6.

Burk JP, Sher KJ. Labeling the child of an Alcoholic: Negative Stereotyping by Mental Health Professionals and Peers. Journal of Studies on Alcohol 1990; 51(2):156-163.

Chen, Bargh J. Nonconscious behavioral confirmation processes: The self-fulfilling consequences of automatic stereotype activation. Journal of experimental social psychology 1997; 33:541-560.

Cleeland CS, Gonin R, Baez L, Loehrer P, Pandya KJ. Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Ann Intern Med 1997; 127(9):813-6.

Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C et al. Race, gender, and partnership in the patient-physician relationship. Jama 1999; 282(6):583-9.

slide36

Cuffe SP, Waller JL, Cuccaro ML, Pumariega AJ, Garrison CZ. Race and gender differences in the treatment of psychiatric disorders in young adolescents. J Am Acad Child Adolesc Psychiatry 1995; 34(11):1536-43.

Curtis JR, Patrick DL, Caldwell E, Greenlee H, Collier AC. The quality of patient-doctor communication about end-of-life care: a study of patients with advanced AIDS and their primary care clinicians. Aids 1999; 13(9):1123-31.

Darley JM, Gross PH. A hypothesis confirming bias in labeling effects. In: Stangor C, editor. Sterotypes and Prejudice. Ann Arbor: Taylor and Francis: Psychology Press, 2000.

Delahanty J, Ram R, Postrado L, Balis T, Green-Paden L, Dixon L. Differences in rates of depression in schizophrenia by race. Schizophr Bull 2001; 27(1):29-38.

DelBello MP, Lopez-Larson MP, Soutullo CA, Strakowski SM. Effects of race on psychiatric diagnosis of hospitalized adolescents: a retrospective chart review. J Child Adolesc Psychopharmacol 2001; 11(1):95-103.

DeVellis BM, Adams JL, DeVellis RF. Effects of information on patient stereotyping. Res Nurs Health 1984; 7(3):237-44.

Devine PG. Stereotypes and prejudice: Their automatic and controlled components. Journal of Personality and Social Psychology 1989; 56:5-18.

Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet 2001; 357(9258):757-62.

Doescher MP, Saver BG. Physicians' advice to quit smoking. The glass remains half empty. J Fam Pract 2000; 49(6):543-7.

Duncan BL. Differential social perception and attribution. Journal of Personality and Social Psychology 1976; 34:22-37.

Dunning D, Sherman DA. Stereotypes and tacit inference. Journal of Personality and Social Psychology 1997; 73:459-471.

Einbinder LC, Schulman KA. The effect of race on the referral process for invasive cardiac procedures. Med Care Res Rev 2000; 57(Suppl 1):162-80.

slide37

Einbinder LC, Schulman KA. The effect of race on the referral process for invasive cardiac procedures. Med Care Res Rev 2000; 57(Suppl 1(12)):162-80.

Eisenberg JM. Sociologic influences on decision-making by clinicians. Ann Intern Med 1979; 90(6):957-64.

Epstein AM, Ayanian JZ, Keogh JH, Noonan SJ, Armistead N, Cleary PD et al. Racial disparities in access to renal transplantation--clinically appropriate or due to underuse or overuse? N Engl J Med 2000; 343(21):1537-44.

Epstein AM, Taylor WC, Seage GR3. Effects of patients' socioeconomic status and physicians' training and practice on patient-doctor communication. Am J Med 1985; 78(1):101-6.

Etchason J, Armour B, Ofili E, Rust G, Mayberry R, Sanders L et al. Racial and ethnic disparities in health care. Jama 2001; 285(7):883.

Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. Jama 2000; 283(19):2579-84.

Fiske ST. Social cognition and social perception. Annu Rev Psychol 1993; 44:155-94.

Flaherty JA, Meagher R. Measuring racial bias in inpatient treatment. Am J Psychiatry 1980; 137(6):679-82.

Furth SL, Garg PP, Neu AM, Hwang W, Fivush BA, Powe NR. Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease. Pediatrics 2000; 106(4):756-61.

Gerbert B. Perceived likability and competence of simulated patients: Influence on physicians' management plans. Social Science and Medicine 1984; 18:1053-1059.

Gilbert D.T, Hixon J.G. The trouble of thinking: Activation and application of stereotypic beliefs. Journal of Personality and Social Psychology 1991; 60(4):509-517.

Greenfield S, Kaplan SH, Ware JE, Jr., Yano EM, Frank HJ. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med 1988; 3(5):448-57.

Greenlund KJ, Keenan NL, Anderson LA, Mandelson MT, Newton KM, LaCroix AZ. Does provider prevention orientation influence female patients' preventive practices? Am J Prev Med 2000; 19(2):104-10.

slide38

Haas JS, Weissman JS, Cleary PD, Goldberg J, Gatsonis C, Seage GR3 et al. Discussion of preferences for life-sustaining care by persons with AIDS. Predictors of failure in patient-physician communication. Arch Intern Med 1993; 153(10):1241-8.

Hall JA, Epstein AM, DeCiantis ML, McNeil BJ. Physicians' liking for their patients: more evidence for the role of affect in medical care. Health Psychol 1993; 12(2):140-6.

Hamilton DL. Cognitive processes in stereotyping and intergroup behavior. Hillsdale, NJ: Erlbaum, 1981.

Hamilton DL, Trolier TK. Stereotypes and stereotyping: An overview of the cognitive approach. In: Dovidio JF, Gaetner SL, editors. Prejudice, Discrimination, and Racism. San Diego: Academic Press, 1986: 127-163.

Hannan EL, van Ryn M, Burke J, Stone D, Kumar D, Arani D et al. Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery. Med Care 1999; 37(1):68-77.

Hooper EM, Comstock LM, Goodwin JM, Goodwin JS. Patient characteristics that influence physician behavior. Med Care 1982; 20(6):630-8.

Kales HC, Blow FC, Bingham CR, Copeland LA, Mellow AM. Race and inpatient psychiatric diagnoses among elderly veterans. Psychiatr Serv 2000; 51(6):795-800.

Kales HC, Blow FC, Bingham CR, Roberts JS, Copeland LA, Mellow AM. Race, psychiatric diagnosis, and mental health care utilization in older patients. Am J Geriatr Psychiatry 2000; 8(4):301-9.

Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE. Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study. Med Care 1995; 33(12):1176-87. Kaplan SH, Greenfield S, Ware JE, Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989; 27(3 Suppl):110-27.

Kearney N, Miller M, Paul J, Smith K. Oncology healthcare professionals' attitudes toward elderly people. Ann Oncol 2000; 11(5):599-601.

Kelly CE. Bringing homophobia out of the closet: antigay bias within the patient-physician relationship. Pharos Alpha Omega Alpha Honor Med Soc 1992; 55(1):2-8.

Kelly JA, St Lawrence JS, Smith S, Hood HV, Cook DJ. Medical students' attitudes toward AIDS and homosexual patients. J Med Educ 1987; 62(7):549-56.

slide39

Kelly JA, St Lawrence JS, Smith S, Jr., Hood HV, Cook DJ. Stigmatization of AIDS patients by physicians. Am J Public Health 1987; 77(7):789-91.

Kilgus MD, Pumariega AJ, Cuffe SP. Influence of race on diagnosis in adolescent psychiatric inpatients. J Am Acad Child Adolesc Psychiatry 1995; 34(1):67-72.

Kogan MD, Kotelchuck M, Alexander GR, Johnson WE. Racial disparities in reported prenatal care advice from health care providers [see comments]. Am J Public Health 1994; 84(1):82-8.

Racial Variation in the Provision of VA Dental Care: The Case of Root Canal Therapy. Washington D.C.: 2001.

Krupat E, Irish JT, Kasten LE, Freund KM, Burns RB, Moskowitz MA et al. Patient assertiveness and physician decision-making among older breast cancer patients. Soc Sci Med 1999; 49(4):449-57.

Kunda Z. Social Cognition: Making Sense of People. Cambridge, MA: Bradford: M.I.T. Press, 1999.

Kunda Z, Sherman-Williams B. Stereotypes and the construal of individuating information. Journal of Personality and Social Psychology 1993; 19:90-99.

Kunda Z, Sinclair L. Motivated Reasoning with Stereotypes:Activatyion, application and Inhibition. Psychological Inquiry 2001.

Kunda Z, Sinclair L, Griffin D. Equal ratings but separate meanings: Steotypes and the construal of traits. Journal of Personality and Social Psychology 1997; 72:720-724.

Kunda Z, Thagard P. Forming impressions from stereotypes, traits and behaviors. Psychological Review 1996; 103:284-208.

Lalonde RN, Gardner RC. The intergroup perspective on stereotype organization and processing. British Journal of Social Psychology 1989; 28(4):289-303.

Lane DS, Zapka J, Breen N, Messina CR, Fotheringham DJ. A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium. Prev Med 2000; 31(5):481-93.

Larson PA. Nurse perceptions of patient characteristics. Nurs Res 1977; 26(6):416-21.

.

slide40

Lawson WB, Hepler N, Holladay J, Cuffel B. Race as a factor in inpatient and outpatient admissions and diagnosis. Hosp Community Psychiatry 1994; 45(1):72-4.

Lepore L, Brown R. Category and Stereotype Activation: Is prejudice inevitable? Journal of Personality and Social Psychology 1997; 72:275-287.

Lewis G, Croft-Jeffreys C, David A. Are British psychiatrists racist? Br J Psychiatry 1990; 157:410-5.

Li VC, Coates TJ, Ewart CK, Kim YJ. The effectiveness of smoking cessation advice given during routine medical care: physicians can make a difference. Am J Prev Med 1987; 3(2):81-6.

Like R, Zyzanski SJ. Patient satisfaction and the clinical encounter: Social psychological determinants. Social Science & Medicine 1987; 24:351-357.

Locke V, MacLeod C, Walker I. Automatic and controlled activation of stereotypes: Individual differences associated with prejudice. British Journal of Social Psychology 1994; 33:29-46.

Locksley A, Hepburn C, Ortiz V. Social stereotypes and judgements of individuals: An instance of the base-rate fallacy. Journal of experimental social psychology 1982; 18:23-42.

Macrae N.C, Hewstone M, Griffiths R.J. Processing load and memory for stereotype based information. European Journal of Social Psychology 1993; 23(1):77-87.

Macrae CN, Bodenhausen GV. Social Cognition: Categorical person perception. British Journal of Social Psychology 2001; 92:239-255.

Macrae CN, Bodenhausen GV, Milne AB. Out of Mind but Back in Sight: Stereotypes on the Rebound. Journal of Personality and Social Psychology 1994; 67:37-47.

Macrae CN, Milne AB, Bodenhausen GV. Stereotypes as energy-saving devices: A peek inside the cognitive toolbox. Journal of Personality and Social Psychology 1994; 66:33-47.

slide41

Martin TW. White therapists' differing perceptions of black and white adolescents. Adolescence 1993; 28(110):281-9.

May DS, Kiefe CI, Funkhouser E, Fouad MN. Compliance with mammography guidelines: physician recommendation and patient adherence. Prev Med 1999; 28(4):386-94.

Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev 2000; 57(Suppl 1):108-45.

Maynard C, Fisher LD, Passamani ER, Pullum T. Blacks in the coronary artery surgery study (CASS): race and clinical decision making. Am J Public Health 1986; 76(12):1446-8.

McKinlay JB, Burns RB, Feldman HA, Freund KM, Irish JT, Kasten LE et al. Physician variability and uncertainty in the management of breast cancer. Results from a factorial experiment. Med Care 1998; 36(3):385-96.

McKinlay JB, Potter DA, Feldman HA. Non-medical influences on medical decision-making. Soc Sci Med 1996; 42(5):769-76.

McMahon LF, Wolfe RA, Huang S, Tedeschi P, Manning W, Edlund MJ. Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population. Med Care 1999; 37(7):712-7.

Monteith MJ, Sherman JW, Devine PG. Suppression as a stereotype control strategy. Personality and Social Psychology Review 1998; 2:63-82.

Mouton C, Teno JM, Mor V, Piette J. Communication of preferences for care among human immunodeficiency virus-infected patients. Barriers to informed decisions? Arch Fam Med 1997; 6(4):342-7.

Naumburg EH, Franks P, Bell B, Gold M, Engerman J. Racial differentials in the identification of hypercholesterolemia. J Fam Pract 1993; 36(4):425-30.

Nichol KL, Mac Donald R, Hauge M. Factors associated with influenza and pneumococcal vaccination behavior among high-risk adults. J Gen Intern Med 1996; 11(11):673-7.

O'Malley MS, Earp JA, Harris RP. Race and mammography use in two North Carolina counties. Am J Public Health 1997; 87(5):782-6.

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O'Malley MS, Earp JA, Hawley ST, Schell MJ, Mathews HF, Mitchell J. The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening? Am J Public Health 2001; 91(1):49-54.

Porter JR, Beuf AH. The effect of a racially consonant medical context on adjustment of African-American patients to physical disability. Med Anthropol 1994; 16(1):1-16.

Pratto, Bargh J. Stereotyping based on apparently individuating information: Trait and global components of sex stereotypes under attention overload. Journal of experimental social psychology 1991; 27(1):26-47.

Rao JK, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes: a literature review. Arch Fam Med 2000; 9(10):1148-55.

Rathore SS, Lenert LA, Weinfurt KP, Tinoco A, Taleghani CK, Harless W et al. The effects of patient sex and race on medical students' ratings of quality of life. Am J Med 2000; 108(7):561-6.

Rayburn TM, Stonecypher JF. Diagnostic differences related to age and race of involuntarily committed psychiatric patients. Psychol Rep 1996; 79(3 Pt 1):881-2.

Revenson TA. Compassionate stereotyping of elderly patients by physicians: revising the social contact hypothesis. Psychol Aging 1989; 4(2):230-4.

Rosenfield S. Race differences in involuntary hospitalization: psychiatric vs. labeling perspectives. J Health Soc Behav 1984; 25(1):14-23.

Roter D. The enduring and evolving nature of the patient-physician relationship. Patient Educ Couns 2000; 39(1):5-15.

Roter DLDSMPPSMMLMJMSWPITSM. Communication Patterns of Primary Care Physicians[The Patient-Physician Relationship]. Jama 1997; 277(4):350-356.

Sagar HA, Schofield JW. Racial and behavioral cues in black and white children's perceptions of ambiguously aggressive acts. Journal of Personality and Social Psychology 1980; 39:590-598.

Schneider AE, Davis RB, Phillips RS. Discussion of hormone replacement therapy between physicians and their patients. Am J Med Qual 2000; 15(4):143-7.

slide43

Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med 1999; 340(8):618-26.

Sedlis SP, Fisher VJ, Tice D, Esposito R, Madmon L, Steinberg EH. Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center. J Clin Epidemiol 1997; 50(8):899-901.

Shortt S. Venerable or vulnerable? Ageism in health care. J Health Serv Res Policy 2001; 6(1):1-2.

Sinclair L. Justifying desired impressions of evaluators: Motivated activation, application and inhibition of stereotypes. University of Waterloo, 1998.

Sollner W, DeVries A, Steixner E, Lukas P, Sprinzl G, Rumpold G et al. How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? Br J Cancer 2001; 84(2):179-85.

Stangor C. Stereotypes and Prejudice. Philadelphia: Psychology Press, 2000.

Stephan WG. Intergroup Relations. In: Lindsay, Aronson, editors. Handbook of Social Psychology. 1985.

Stern M, Arenson E. Childhood cancer stereotype: impact on adult perceptions of children. J Pediatr Psychol 1989; 14(4):593-605.

Stern M, Moritzen SK, Carmel S, Olexa-Andrews M. The prematurity stereotype in Israeli health care providers. Med Educ 2001; 35(2):129-33.

Stern M, Ross S, Bielass M. Medical students' perceptions of children: modifying a childhood cancer stereotype. J Pediatr Psychol 1991; 16(1):27-38.

Stewart M, Brown JB, Boon H, Galajda J, Meredith L, Sangster M. Evidence on patient-doctor communication. Cancer Prev Control 1999; 3(1):25-30.

Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW et al. The impact of patient-centered care on outcomes. J Fam Pract 2000; 49(9):796-804.

Strakowski SM, Hawkins JM, Keck PE, Jr., McElroy SL, West SA, Bourne ML et al. The effects of race and information variance on disagreement between psychiatric emergency service and research diagnoses in first-episode psychosis. J Clin Psychiatry 1997; 58(10):457-63.

slide44

Strakowski SM, Lonczak HS, Sax KW, West SA, Crist A, Mehta R et al. The effects of race on diagnosis and disposition from a psychiatric emergency service. J Clin Psychiatry 1995; 56(3):101-7.

Strakowski SM, Shelton RC, Kolbrener ML. The effects of race and comorbidity on clinical diagnosis in patients with psychosis. J Clin Psychiatry 1993; 54(3):96-102.

Taira DA, Safran DG, Seto TB, Rogers WH, Tarlov AR. The relationship between patient income and physician discussion of health risk behaviors. Jama 1997; 278(17):1412-7.

Takei N, Persaud R, Woodruff P, Brockington I, Murray RM. First episodes of psychosis in Afro-Caribbean and White people. An 18-year follow-up population-based study. Br J Psychiatry 1998; 172:147-53.

Tates K, Meeuwesen L. Doctor-parent-child communication. A (re)view of the literature. Soc Sci Med 2001; 52(6):839-51.

Thomson GE. Discrimination in health care. Ann Intern Med 1997; 126(11):910-2.

Todd KH, Deaton C, D'Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med 2000; 35(1):11-6.

Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. Jama 1993; 269(12):1537-9.

Trierweiler SJ, Neighbors HW, Munday C, Thompson EE, Binion VJ, Gomez JP. Clinician attributions associated with the diagnosis of schizophrenia in African American and non-African American patients. J Consult Clin Psychol 2000; 68(1):171-5.

van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med 2000; 50(6):813-28.

An Examination of Factors Associated with Physician Recommendation for Revascularization. 99; 1999.

Vassiliou V, Trandis H, Vassiliou G, McGuire H. Interpersonal contact and stereotyping. In: Triandis H, editor. The Analysis of Subjective Culture. New York: Wiley, 1972.

Weisse CS, Sorum PC, Sanders KN, Syat BL. Do Gender and Race Affect Decisions About Pain Management? J Gen Intern Med 2001; 16(4):211-217.

slide45

Whaley AL. Racism in the provision of mental health services: a social-cognitive analysis. Am J Orthopsychiatry 1998; 68(1):47-57.

Whittle J, Conigliaro J, Good CB, Joswiak M. Do patient preferences contribute to racial differences in cardiovascular procedure use? J Gen Intern Med 1997; 12(5):267-73.

Wissow LS, Roter DL, Wilson ME. Pediatrician interview style and mothers' disclosure of psychosocial issues. Pediatrics 1994; 93(2):289-95.

Won A, Lapane K, Gambassi G, Bernabei R, Mor V, Lipsitz LA. Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology. J Am Geriatr Soc 1999; 47(8):936-42.

Word, Zanna MP, Cooper J. The nonverbal mediation of self-fulfilling prophecies in interracial interaction. Journal of experimental social psychology 1974; 10:109-120