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

项目摘要/摘要 晚期实体癌症患者的预后仍然很差，特别是在少数族裔中。尽管病人- 而系统层面的因素是导致癌症差异的重要因素，与医生相关的因素，如 内隐偏见也起着重要作用。虽然可能会发生罕见的显性歧视，但 医生之间的隐性偏见被认为主要是无意的，发生在无意识的水平上。 隐性偏见指的是个体在对他人做出判断时利用无意识信念 来自不同群体(例如，种族/民族群体)。有效的医患沟通对于 提供最佳的病人护理，并与结果直接相关。研究表明，医生 与少数族裔患者沟通不充分，但隐性偏见的作用，一个潜在的可修改因素， 还没有经过评估。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到目前为止，将作为干预的基础 对肿瘤学家和癌症患者来说。更深入地了解这些差异背后的原因 接受治疗将是改善65,000名被诊断为艾滋病的少数民族患者预后的重要一步 每年都有晚期癌症。其具体目的是：1)评估肿瘤学家的内隐偏见是否能解释 在讨论癌症治疗期间，以患者为中心的沟通中的种族/民族差异 在晚期实体癌患者中；2)检查肿瘤学家的内隐偏见在解释种族方面的作用 心理困扰、沟通满意度和治疗相关的民族差异 决策冲突：晚期实体癌症患者；3)评估内隐偏见是否能解释种族/民族差异 在肿瘤学家对疼痛的评估中，使用与指南一致的疼痛管理和疼痛控制 晚期实体癌患者。我们计划研究60位肿瘤学家和360位会说英语的肿瘤学家 晚期实体癌患者。招募工作将在纽约州东哈莱姆区种族多元化的MSHS进行 和北卡罗来纳州达勒姆的DUHS。我们将使用内隐联想测试，这是一种经过验证的内隐偏见测量工具，以 评估肿瘤学家。我们将录制肿瘤学家与他们的6名患者的临床会面 开始一线或二线化疗后的影像评估，以确定患者- 将沟通集中在癌症治疗的讨论上。参观前、参观后立即和后续- 3个月和6个月后的UP调查将评估他们的疼痛控制水平、心理困扰、对 与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 评估和使用符合指南的疼痛管理。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、 和病人的结果。我们的项目所产生的知识可以让医生级别的教育 计划和针对患者的干预措施。

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.