Grant Number:	5R01CA251547-05 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:	2025

Different population groups with advanced cancer have poorer health outcomes, and many differences remain unchanged or increasing over time. Although patient- and system-level factors are important contributors to these differences, physician-related factors such as unconscious patterns in oncologist decision-making also play a significant role. Effective patient-physician communication is essential to providing optimal patient care and is directly linked to outcomes. Research demonstrates that oncologists face challenges in effectively communicating with patients from varied backgrounds, but the role of oncologists’ decision-making, a potentially modifiable factor, has not been evaluated. This study would collect one of the largest datasets of conversations between oncologists and their patients to date and would serve as the foundation for an intervention for oncologists and patients with cancer. A more in-depth knowledge of the reasons underlying these differences in cancer care outcomes will be an important step toward improving the outcomes of those patients diagnosed with advanced cancer each year. The Specific Aims are to: 1) Evaluate the association between oncologist decision making patterns and variation in objectively assessed patient-centered communication among population groups with advanced solid cancer as defined by differences in health outcomes; 2) Examine whether oncologists’ decision-making patterns are associated with variation in psychological distress and satisfaction with communication among patients with advanced solid cancer; 3) Assess whether oncologists’ decision-making patterns are associated with variation in pain assessment, 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 patients with advanced solid cancer. Recruitment will occur at the Mount Sinai Health System in East Harlem, NY and Duke University Health System in Durham, NC. We will use the Implicit Association Test, to assess oncologists’ unconscious patterns in clinician decision-making. 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 and satisfaction with communication. 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 oncologist decision-making, communication processes, management, and patient outcomes. The knowledge generated by our project could inform both physician-level educational programs and patient-specific interventions.





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