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Principal Investigator: Cardinale B Smith
Organization: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Fiscal Year: 2024
Award: $642,048
Funding agency: National Cancer Institute
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.
Terms: <Active Follow-up><Address><Advanced Cancer><Advanced Malignant Neoplasm><Affect><Analgesia Tests><Belief><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Cancer Patient><Cancer Treatment><Cancers><Caring><Cognitive Discrimination><Communication><Conflict><Conflict (Psychology)><Data><Data Set><Diagnosis><Discrimination><Disparities><Disparity><Educational Achievement><Educational Status><Equity><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Evaluation><Foundations><Goals><Guidelines><Health system><Hispanic><Hispanic Populations><Hispanic group><Hispanic individual><Hispanic people><Hispanics><Image><Implicit Association Test><Incidence><Individual><Inequity><Inferior><Institute of Medicine><Institute of Medicine (U.S.)><Institutional Racism><Intervention><Intervention Strategies><Interview><Judgment><Knowledge><Link><Malignant Neoplasm Therapy><Malignant Neoplasm Treatment><Malignant Neoplasms><Malignant Tumor><Measures><Mediating><Minority><NAS/IOM><New York City><Nociception Tests><Oncologist><Oncology><Oncology Cancer><Outcome><Pain><Pain Assessment><Pain Control><Pain Measurement><Pain Therapy><Pain management><Pain measure><Painful><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Persons><Physicians><Play><Population><Process><Prognosis><QOL><Quality of life><Race><Races><Racial Group><Recommendation><Reporting><Research><Role><Solid><Survey Instrument><Surveys><System><Systematic Racism><Systemic Racism><Time><Translating><Unconscious><Unconscious State><Unconsciousness><Universities><Visit><active followup><anti-cancer therapy><cancer care><cancer disparity><cancer health disparity><cancer therapy><cancer-directed therapy><cancer-related health disparity><care for patients><care of patients><caring for patients><chemotherapy><clinical encounter><clinician factors><clinician-level factors><consciousness loss><cultural competence><culturally competent><differences due to race><differences in race><differs by race><differs in race><disparate effect><disparate impact><disparate result><disparities in race><disparity due to race><disparity in cancer><disparity in care><disparity in ethnic><disparity in healthcare><educational level><ethnic based disparity><ethnic difference><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnic subgroup><ethnicity difference><ethnicity disparity><ethnicity group><follow up><follow-up><followed up><followup><group of color><health care disparity><health care inequality><health care inequity><healthcare disparity><healthcare inequality><healthcare inequity><imaging><implicit bias><improved><improved outcome><individual of color><inequality due to race><inequitable effect><inequitable impact><inequitable outcome><inequity due to race><instrument><interventional strategy><malignancy><minority patient><neoplasm/cancer><outcome disparities><outcome inequality><outcome inequity><pain assay><pain relief><pain treatment><patient centered><patient oriented><patient oriented outcomes><patients from minority><patients of minority><people of color><person of color><physician factors><physician-level factors><population of color><preference><programs><provider factors><provider-level factors><psychological distress><race based differences><race based disparity><race based inequality><race based inequity><race differences><race disparity><race related differences><race related disparity><race related inequality><race related inequity><racial><racial background><racial difference><racial disparity><racial diversity><racial inequality><racial inequity><racial origin><racial population><racial subgroup><racially different><racially diverse><racially unequal><recruit><relieve pain><satisfaction><social role><training achievement><training level><training status><unequal effect><unequal impact><unequal outcome>