Background/Purpose: Medical education can promote bias that disproportionately affects patients of color. Patients of color with lupus are especially vulnerable as they often carry a greater disease burden, yet studies show that individuals with darker skin tones are underrepresented in medical educational materials. Given this disparity, we surveyed practitioners’ confidence assessing rashes in patients with lupus and skin of color (SOC) and identified factors that may influence confidence.

Methods: We designed a survey to collect demographic information and measure providers’ confidence assessing any rash and rashes in patients with lupus and varied skin tones. We invited providers in the Greater St. Louis Area to participate, distributing surveys in person and via Qualtrics. For our primary outcome, we compared Likert scores for providers’ confidence assessing rashes in patients with lupus and SOC with least square means and pairwise differences. To identify variables that correlate with practitioners’ confidence, we created univariate linear models and multivariate generalized linear models using Spearman’s rank correlation coefficients and backward selection. We set statistical significance at p< 0.05 for all analyses.

Results: In total, 132 providers participated (Table 1). The mean confidence level diagnosing any rash was significantly higher than diagnosing lupus rashes, including in patients with fair skin and SOC (p=0.03; 0.049; < 0.0001). The mean confidence diagnosing lupus rashes in patients with fair skin was also significantly higher than confidence diagnosing lupus rashes in patients with SOC (p=0.0090). Mean confidence levels for each specialty were collected (Table 2). Univariate analysis found that provider specialty, years in practice, extent of training, experience in diagnosing, and frequency of treating white or African American patients correlated with confidence level diagnosing lupus rashes in patients of color. However, in the final multivariate model, only practitioners’ self-reported experience level diagnosing rashes in patients with lupus and SOC correlated with their confidence doing the same (p=< 0.001). Lastly, 92% of participants indicated interest in education about lupus rashes and 93% wanted to learn about rashes in patients of color.

Conclusion: Healthcare providers are less confident evaluating lupus-related rashes in SOC compared to fair skin, representing a disparity between provider confidence and the patient population lupus traditionally affects. While our univariate model demonstrated correlations among confidence in diagnosing rashes in patients with lupus and SOC and several factors, the multivariate model revealed a relationship between confidence and experience alone. Based upon the principle of collinearity, we believe specialty, years in practice, extent of training, and frequency of treating different ethnicities may all contribute to provider experience level. Training is unique as it can be modified immediately. Over 90% of participants were interested in education on this topic. Future educational interventions may help practitioners improve their confidence when diagnosing rashes in lupus patients with SOC.

Characteristics of Participants at Baseline

Distribution of provider characteristics regarding extent of training, experience in diagnosing, and confidence diagnosing rashes as a function of provider specialty training

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/healthcare-practitioner-confidence-assessing-rashes-in-patients-of-skin-of-color-with-lupus/