R01CA251547

The Role of Implicit Bias on Outcomes of Patients with Advanced Solid Cancers - 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 over 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 psychological distress, satisfaction with communication, and treatment-related decisional conflict among 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, psychological 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.

Icahn School Of Medicine At Mount Sinai

TO IDENTIFY CANCER RISKS AND RISK REDUCTION STRATEGIES, TO IDENTIFY FACTORS THAT CAUSE CANCER IN HUMANS, AND TO DISCOVER AND DEVELOP MECHANISMS FOR CANCER PREVENTION AND PREVENTIVE INTERVENTIONS IN HUMANS. RESEARCH PROGRAMS INCLUDE: (1) CHEMICAL, PHYSICAL AND MOLECULAR CARCINOGENESIS, (2) SCREENING, EARLY DETECTION AND RISK ASSESSMENT, INCLUDING BIOMARKER DISCOVERY, DEVELOPMENT AND VALIDATION, (3) EPIDEMIOLOGY, (4) NUTRITION AND BIOACTIVE FOOD COMPONENTS, (5) IMMUNOLOGY AND VACCINES, (6) FIELD STUDIES AND STATISTICS, (7) CANCER CHEMOPREVENTION AND INTERCEPTION, (8) PRE-CLINICAL AND CLINICAL AGENT DEVELOPMENT, (9) ORGAN SITE STUDIES AND CLINICAL TRIALS, (10) HEALTH-RELATED QUALITY OF LIFE AND PATIENT-CENTERED OUTCOMES, AND (11) SUPPORTIVE CARE AND MANAGEMENT OF SYMPTOMS AND TOXICITIES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO STIMULATE TECHNICAL INNOVATION, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, AND FOSTER PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS.

93.393 - Cancer Cause and Prevention Research

National Cancer Institute (NCI) [HHS - NIH]

New York United States

State-Wide

Research Supplements to Promote Diversity in Health-Related Research (Admin Supp Clinical Trial Not Allowed) (PA-23-189)

Amendment Since initial award the End Date has been shortened from 03/31/26 to 03/31/25 and the total obligations have increased 409% from $708,475 to $3,605,222.