Grant Number:	5R01CA251547-03 Interpret this number
Primary Investigator:	Smith, Cardinale
Organization:	Icahn School Of Medicine At Mount Sinai
Project Title:	The Role of Implicit Bias on Outcomes of Patients with Advanced Solid Cancers
Fiscal Year:	2023

PROJECT SUMMARY/ABSTRACT 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.





None