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. 2025 Jun 25;20(6):e0325315.
doi: 10.1371/journal.pone.0325315. eCollection 2025.

Effects of patient race on processes and experiences of clinical interactions in US emergency departments: A mixed-methods systematic review

Tommy J Flynn  1   2 , Bonnie Mowinski Jennings  2 , David W Wright  3 , Ymir Vigfusson  4 , Dian D Evans  2 , Vicki Hertzberg  2 , Emily J Burns  2 , Katherine A Yeager  2
Affiliations

Effects of patient race on processes and experiences of clinical interactions in US emergency departments: A mixed-methods systematic review

Tommy J Flynn et al. PLoS One. .

Abstract

Background: Evidence shows that patients identified as Black experience worse emergency department (ED) care compared to patients identified as White. Clinical interactions (CI) are thought to affect racial disparities, but no systematic reviews to date have synthesized the evidence on the effects of patient race on CI processes and experiences.

Objective: We synthesized evidence from published studies comparing observed and/or patient-reported CI processes and experiences between patients identified as Black and White in US EDs.

Methods: This was a mixed-methods systematic review following the Joanna Briggs Institute guidelines and registered a priori with PROSPERO (CRD42021281653). We used a broad search strategy to query six databases. Peer-reviewed original research reports comparing processes or experiences of CIs between Black and White patients in US EDs from 2004 to 2024 were eligible for inclusion.

Results: Nine studies met inclusion criteria. Of these, three focused on observational CI processes and six focused on patient-reported CI experiences. Evidence of differences in CI processes and patient-reported experiences between Black and White patients was inconclusive. We identified four themes across measures used in studies of patient reported CI experiences, however, including responsive nonverbal behavior, effective verbal communication, person centeredness, and patient satisfaction.

Discussion: Research on the effects of patient race on ED CIs is lacking, especially research with observed real-world CI processes. Psychometrically robust instruments and conceptual clarity in the study of racial disparities in CI experiences are needed. We provide groundwork for future research development on racial disparities in ED CIs.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Data sources & screening process (PRISMA) flow diagram.
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources from Page et al. [53], distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, available at https://creativecommons.org/licenses/by/4.0/.
Fig 2
Fig 2. Literature screening decision tree.
A decision tree, based on the inclusion and exclusion criteria, guided reviewers’ decisions. Reviewers answered a series of questions to help identify articles for inclusion based on publication type (Peer reviewed research article published in English after January 1, 2004), setting (ED in the US), exposure (clinical interactions), and comparator (Compared patients identified as Black or White). ED = emergency department.
See this image and copyright information in PMC

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