Intersectional Biases Impacting Sickle Cell Patient Care

Research from UChicago Medicine has found that clinician bias toward patients with sickle cell disease (SCD) is primarily driven by the stigma associated with opioid use.

The study, published in the Journal of the American Medical Association (JAMA) Network Open, suggests that this specific stigma influences the language clinicians use in medical records more than race or chronic pain alone.

To identify these patterns, the research team utilized machine learning and natural language processing (NLP) to analyze the electronic health records (EHR) of more than 18,000 adult patients.

The analysis covered nearly 40,000 clinician notes, searching for negative descriptors used to describe patients.

Impact of Biased Language in Medical Records

The researchers identified a recurring use of negative descriptors in the clinical notes of patients with SCD, including terms such as aggressive, noncooperative, and noncompliant.

The study found that the presence of this biased language in patient records is associated with decreased clinician empathy.

the use of these negative descriptors is linked to a less accurate recall of critical health details regarding the patient.

Nationwide, patients with sickle cell disease are not receiving the same quality of care that other patients experience

Austin Wesevich, MD, hematologist and health services researcher at the University of Chicago Medicine

Broader Context of Sickle Cell Disease Bias

Sickle cell disease is the most common monogenetic condition in the United States and has a history of negative bias within the medical establishment.

Since the condition was first described approximately 120 years ago, the medical establishment has reinforced assumptions and biases that have directly and indirectly harmed patients.

Negative stigmas have been applied to those living with SCD by researchers, legislators, society, and healthcare providers.

Other research involving 284 Black adults living with SCD has examined how race-based and disease-based discrimination in healthcare relates to depressive symptoms and internalized stigma.

Efforts to Mitigate Clinician Bias

To address these disparities in care, an anti-bias curriculum is currently being tested to improve the quality of care for patients with sickle cell disease.

This educational approach focuses on skills-based learning and the use of roleplay to help clinicians identify and mitigate their biases.