The Role of Implicit Bias on Outcomes of Patients with Advanced Solid Cancers

隐性偏见对晚期实体癌患者预后的作用

• 批准号: 10211612
• 负责人: Cardinale B Smith
• 金额: $ 70.85万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-05 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10211612
• 关键词: Address; Advanced Malignant Neoplasm; Affect; Americas; Belief; Cancer Patient; Caring; Color; Communication; Conflict (Psychology); Data; Data Set; Diagnosis; Discrimination; Educational Status; Ethnic group; Evaluation; Foundations; Goals; Guidelines; Health system; Hispanics; Image; Implicit Association Test; Incidence; Individual; Inferior; Institute of Medicine (U.S.); Institutional Racism; Intervention; Interview; Judgment; Knowledge; Link; Malignant Neoplasms; Measures; Mediating; Minority; New York City; Oncologist; Oncology; Outcome; Pain; Pain Measurement; Pain management; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Play; Population; Process; Prognosis; Quality of life; Recommendation; Reporting; Research; Role; Solid; Surveys; System; Time; Translating; Unconscious State; Universities; Visit; cancer care; cancer health disparity; cancer therapy; chemotherapy; clinical encounter; cultural competence; ethnic difference; follow-up; health care disparity; implicit bias; improved; improved outcome; instrument; pain relief; patient oriented; preference; programs; provider factors; psychological distress; racial and ethnic; racial and ethnic disparities; racial difference; racial diversity; recruit; satisfaction

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.

项目总结/摘要 晚期实体癌患者的结果仍然很差，特别是在少数民族中。虽然耐心- 和系统水平的因素是癌症差异的重要贡献者， 内隐偏见也起着重要作用。虽然可能会发生罕见的明确歧视案件， 医生中的内隐偏见被认为主要是无意的，发生在无意识的水平。 内隐偏见是指个体在对他人做出判断时对无意识信念的利用 来自不同的组（例如，种族/族裔群体）。有效的医患沟通是至关重要的， 提供最佳的患者护理，并与结果直接相关。研究表明，医生 与少数民族患者沟通不足，但隐性偏见的作用，一个潜在的可修改的因素， 尚未进行评估。这项研究将收集最大的对话数据集之一， 肿瘤学家和他们的黑人和西班牙裔患者迄今为止，将作为干预的基础 为肿瘤学家和癌症患者准备的。更深入地了解这些差异背后的原因 这将是改善65，000多名少数民族患者预后的重要一步， 每年都有癌症。具体目的是：1）评估肿瘤学家的内隐偏见是否解释了 在讨论癌症管理期间，以患者为中心的沟通中存在种族/民族差异 在晚期实体癌患者中; 2）检查肿瘤学家在解释种族歧视方面的隐性偏见的作用 心理困扰、沟通满意度和治疗相关的种族差异 决策冲突晚期实体癌患者; 3）评估内隐偏见是否解释了种族/民族差异 在肿瘤学家对疼痛的评估中， 晚期实体癌患者。我们计划研究60名肿瘤学家和360名讲英语的 晚期实体癌患者。招聘将发生在种族多元化的MSHS在东哈莱姆，纽约 和北卡罗来纳州达勒姆的DUHS。我们将使用内隐联想测验，一种有效的内隐偏见测量方法， 评估肿瘤学家。我们将音频记录肿瘤学家与6名患者的临床接触， 在开始一线或二线化疗后进行影像学评估，以确定患者 在讨论癌症管理时集中交流。访视前、访视后即刻和随访- 调查，3个月和6个月后将评估他们的疼痛控制水平，心理困扰， 沟通和治疗相关的决策冲突。我们还将收集有关医生疼痛的数据 评估和使用指南一致的疼痛管理。我们的研究意义重大，因为研究结果将 加深我们对隐性偏见、沟通过程、管理 和患者结局。我们的项目所产生的知识可以告知医生级的教育 方案和针对患者的干预措施。