JMIR Publications

ABSTRACT

Background:

Compared to White patients, minoritized patients (characterized as Black and Hispanic) have a higher incidence of advanced solid cancers and also have higher mortality. [1,2] These patients also report poor patient-centered communication and worse pain assessment and management. Although many factors contribute to these disparities, physician implicit bias might be a contributor. [3]

Objective:

The primary goal of this study is to evaluate the role of implicit bias among oncologists and examine the impact racial/ethnic differences in objective assessments of communication with minorities with advanced cancer.

Methods:

To accomplish this goal, we are recruiting 65 oncologists and 325 patients (5 patients per oncologist) with advanced solid cancer from ambulatory cancer clinics within the diverse settings of the Mount Sinai Health System in New York City and the Duke University Health System in Durham, NC. We are currently audio recording patient-oncologist encounters during a post-imaging visit over three encounters. We will analyze the recorded visits and compare the patient-centered communication (PCC) content of these conversations. Immediately after the recorded visit (no more than 2 weeks after to minimize recall bias), patients complete a follow-up survey to obtain patient-centered outcomes. A follow-up survey at 3-months assesses pain levels and control, use of analgesics and psychologic distress. A 6-month follow-up survey assesses psychological distress. We are administering the Implicit Association Test (IAT) to oncologists to assess their level of implicit bias towards patients who identify as Black or Hispanic after we finish recording patient encounters.

Results:

Funding by the National Cancer Institute (NCI) was received in March of 2021. Patient and oncologist recruitment began in March 2022.

Conclusions:

In this paper, we outline methods, describe the development of a codebook to assess pain conversations we are using to assess primary and secondary outcomes, and discuss challenges and lessons learned throughout the study.