The outcomes of advanced solid cancer patients remain poor, particularly among minorities. Although patient-
and system-level factors are important contributors to cancer disparities, physician-related factors such as
implicit bias also play a significant role. While rare cases of explicit discrimination may occur, the presence of
implicit bias among physicians is considered to be mainly unintentional, occurring at an unconscious level.
Implicit bias refers to an individual’s utilization of unconscious beliefs when making judgments about people
from different groups (e.g., racial/ethnic groups). Effective patient-physician communication is essential to
providing optimal patient care and is directly linked to outcomes. Research demonstrates that physicians
inadequately communicate with minority patients but the role of implicit bias, a potentially modifiable factor,
has not been evaluated. This study would collect one of the largest datasets of conversations between
oncologists and their Black and Hispanic patients to date and would serve as the foundation for an intervention
for oncologists and cancer patients. A more in-depth knowledge of the reasons underlying these disparities
in care will be an important step toward improving the outcomes of >65,000 minority patients diagnosed with
advanced cancer each year. The Specific Aims are to: 1) Evaluate whether oncologists’ implicit bias explains
racial/ethnic disparities in patient-centered communication during discussions about cancer management
among advanced solid cancer patients; 2) Examine the role of oncologists’ implicit bias in explaining racial
and ethnic differences in psychologic distress, satisfaction with communication and treatment related
decisional conflict advanced solid cancer patients; 3) Assess if implicit bias explains racial/ethnic disparities
in oncologists’ assessment of pain, use of guideline-concordant pain management and pain control among
patients with advanced solid cancer. We propose to study 60 oncologists and 360 of their English-speaking
patients with advanced solid cancer. Recruitment will occur in the racially diverse MSHS in East Harlem, NY
and DUHS in Durham, NC. We will use the Implicit Association Test, a validated measure of implicit bias, to
assess oncologists. We will audio record clinical encounters of oncologists with 6 of their patients undergoing
imaging assessment following initiation of first- or second-line chemotherapy to identify differences in patient-
centered communication in discussions about cancer management. Pre-visit, immediate post-visit and follow-
up surveys, 3- and 6-months later will assess their level of pain control, psychologic distress, satisfaction with
communication and treatment related decisional conflict. We will also collect data on physician’s pain
assessment and use of guideline-concordant pain management. Our study is significant because findings will
deepen our understanding of relationships between implicit bias, communication processes, management,
and patient outcomes. The knowledge generated by our project could inform both physician-level educational
programs and patient-specific interventions.
If you are accessing this page during weekend or evening hours, the database may currently be offline for maintenance and should operational within a few hours. Otherwise, we have been notified of this error and will be addressing it immediately.
Please contact us
if this error persists.
We apologize for the inconvenience.
- The DCCPS Team.