Higher implicit racial bias among non-black oncologists was associated with aspects of their interactions and care of non-black patients, investigators report.
In a study of 18 non-black oncologists and 112 black patients, oncologists who were higher in implicit racial bias had shorter interactions with the black patients, and those interactions were rated less supportive by observers and patients. Higher implicit bias was also associated with more patient difficulty remembering contents of the interaction, Louis A. Penner, Ph.D., of Karmanos Cancer Institute, Detroit, and his associates reported (J Clin Oncol. 2016 Jun. doi: 10.1200/JCO.2015.66.3658).
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“We acknowledge it is unlikely racial bias alone [that] is the major source of the well-documented, widespread racial disparities in cancer treatment. Factors such as patient socioeconomic status, limited access to high-quality health care, and patients’ health-related attitudes also contribute to racial disparities in cancer treatment. However, our data suggest that oncologist implicit racial bias may uniquely contribute to these disparities and should be further explored,” wrote Dr. Penner and his associates.
For the study, oncologists completed the Implicit Association Test that measured implicit racial bias prior to professional interaction. Patients also completed a baseline questionnaire prior to their appointment with an oncologist. Patients and physicians then had an appointment to discuss initial treatment for a current cancer. Patient questionnaires measuring perception of oncologist, the interaction, and recommended treatments, and physician questionnaires measuring patient participation were completed following the appointment. In addition, 96 of 112 appointments were videotaped and reviewed by four – two black and two white – researchers to assess various aspects of the physician-patient interaction.
Bivariate multilevel models revealed that higher implicit racial bias among oncologists was significantly associated to shorter appointment times (P = .02) and decreased use of supportive communication (P less than .01 when controlling for physician age). Implicit racial bias was not significantly correlated to talk-time ratio (P = .27) nor to the extent to which oncologists involved their patients in treatment decisions (P = .22).
Higher implicit racial bias was associated with patients experiencing greater difficulty remembering conversation contents (P less than .01) and patients perceiving the conversation as being less patient-centered (P = .01). Higher implicit racial bias was not significantly correlated to patient’s perception of treatment plans discussed (P = .19), post-visit distress (P = .57), or trust in their oncologist (P = .08).
This study was funded by the National Cancer Institute and the research advisory committee of the Southeast Michigan Partners Against Cancer. Eleven investigators had no relevant disclosures to report. The three other investigators reported serving in advisory roles for, receiving financial compensation or honoraria from, or participating in the speakers bureau of multiple companies.
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