Implicit Bias and Microaggressions in the Care of People With Prolonged Disorders of Consciousness: Bridging Medicine, Disability Studies, and Family Advocacy.

BACKGROUND: Prolonged Disorders of Consciousness (PDOC), including unresponsive wakefulness syndrome and minimally conscious state, present persistent challenges in clinical assessment and long-term care. Although behavioral observation remains the primary basis for detecting signs of consciousness, interpretation of such observations often depends on clinical judgment and contextual information provided by caregivers. In some cases, family caregivers may detect subtle signs of recovery in individuals with PDOC; however, these observations are not always incorporated into clinical assessment or diagnostic interpretation due to the inherent ambiguity of behavioral responses.

AIM AND METHOD: This study explores how implicit biases and microaggressions may influence the interpretation of caregiver observations in PDOC care. Furthermore, it introduces a conceptual framework-the Context-Dependent Diagnostic Sensitivity Model-to illustrate how clinical awareness of bias and improved communication with families may contribute to more accurate diagnostic interpretation. Semi-structured interviews were conducted with seven family caregivers of individuals with PDOC living in home healthcare settings in Japan. Using thematic analysis, the study examined caregivers' experiences of communication and interaction with healthcare professionals.

FINDINGS: Caregivers frequently reported situations in which their interpretations of patient responses were minimized or reframed as unrealistic expectations. Such interactions sometimes limited the incorporation of caregiver observations into clinical assessment and decision-making processes. These findings suggest that subtle forms of bias embedded in professional communication may influence opportunities for behavioral observation and family participation in care.

CONCLUSION: By integrating qualitative findings with insights from disability studies and research on implicit bias, this study highlights the potential impact of microaggressions on diagnostic sensitivity and clinical interaction in PDOC care. Recognizing and addressing these dynamics may contribute to improved collaboration between healthcare professionals and family caregivers, as well as to the development of more effective clinical practices.