The psychosocial effect of thoughts of personal mortality on cardiac risk assessment.

Background: Prejudice by medical providers has been found to contribute to differential cardiac risk estimates. As such, empirical examinations of psychological factors associated with such biases are warranted. Considerable psychological research implicates concerns with personal mortality in motivating prejudicial biases. The authors sought to examine whether provoking thoughts of mortality among medical students would engender more cautious cardiac risk assessments for a hypothetical Christian than for a Muslim patient.

Methods: During the spring of 2007, university medical students (N=47) were randomly assigned to conditions in a 2 (mortality salience) x 2 (patient religion) full factorial experimental design. In an online survey, participants answered questions about their mortality or about future uncertainty, inspected emergency room admittance forms for a Muslim or Christian patient complaining of chest pain, and subsequently estimated risk for coronary artery disease, myocardial infarction, and the combined risk of either of the two. A composite risk index was formed based on the responses (on a scale of 0-100) to each of the 3 cardiac risk questions.

Results: Reminders of mortality interacted with patient religion to influence risk assessments, F(1,41)=11.57, P=0.002, eta2 =.22. After being reminded of mortality, participants rendered more serious cardiac risk estimates for a Christian patient (F1,41 =8:66, P=0:01) and less serious estimates for a Muslim patient (F(1,41)=4.08, P=0.05).

Conclusion: Reminders of personal mortality can lead to biased patient risk assessment as medical providers use their cultural identification to psychologically manage their awareness of death.