Physicians' Perceptions of Race and Engagement in Race-Based Clinical Practice: a Mixed-Methods Systematic Review and Narrative Synthesis.

Background: Using race-a socially assigned identity that does not adequately capture human genetic variation-to guide clinical care can result in poor outcomes for racially minoritized patients. This study assessed (1) how physicians conceptualize and use race in their clinical care (race-based care) and (2) physician characteristics associated with race-based care.

Methods: PubMed, CINAHL, EMBASE, and Scopus databases were searched. Qualitative, quantitative, and mixed-methods studies written in peer-reviewed, English-language journal articles evaluating US physicians' perceptions of race and physician factors associated with race-based care were included. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were evaluated using thematic analysis, and quantitative findings were summarized and combined with qualitative findings in a narrative synthesis.

Results: A total of 1149 articles were identified; 9 (4 qualitative, 5 quantitative) studies met inclusion criteria. Five themes emerged: (1) the belief in race as biological; (2) the use of race to contextualize patients' health; (3) the use of race to counsel patients and determine care; (4) justifications for race-based practice (evidence-based, personal experience, addresses disparities, provides personalized care, increases compliance); and (5) concerns with race-based practice (poorly characterizes patients, normalizes disparities, patient distrust, clinician discomfort, legitimized biological race). In quantitative studies, older age was positively associated with race-based care.

Discussion: Physicians had varied perceptions of race, but many believed race was biological. Concern and support for race-based practice were related to beliefs regarding the evidence for using race in care and the appropriateness of race as a variable in medical research. Older physicians were more likely to use race, which could be due to increased exposure to race-based medical literature, in addition to generational differences in conceptualizations of race. Additional research on the evolution of physicians' perceptions of race, and the role of medical literature in shaping these perceptions, is needed.