The Effects of Oncologist Implicit Racial Bias in Racially Discordant Oncology Interactions.
Health providers' implicit racial bias negatively affects communication and patient reactions to many medical interactions. However, its effects on racially discordant oncology interactions are largely unknown. Thus, we examined whether oncologist implicit racial bias has similar effects in oncology interactions. We further investigated whether oncologist implicit bias negatively affects patients' perceptions of recommended treatments (i.e., degree of confidence, expected difficulty). We predicted oncologist implicit bias would negatively affect communication, patient reactions to interactions, and, indirectly, patient perceptions of recommended treatments.



Participants were 18 non-black medical oncologists and 112 black patients. Oncologists completed an implicit racial bias measure several weeks before video-recorded treatment discussions with new patients. Observers rated oncologist communication and recorded interaction length of time and amount of time oncologists and patients spoke. Following interactions, patients answered questions about oncologists' patient-centeredness and difficulty remembering contents of the interaction, distress, trust, and treatment perceptions.



As predicted, oncologists higher in implicit racial bias had shorter interactions, and patients and observers rated these oncologists' communication as less patient-centered and supportive. Higher implicit bias also was associated with more patient difficulty remembering contents of the interaction. In addition, oncologist implicit bias indirectly predicted less patient confidence in recommended treatments, and greater perceived difficulty completing them, through its impact on oncologists' communication (as rated by both patients and observers).



Oncologist implicit racial bias is negatively associated with oncologist communication, patients' reactions to racially discordant oncology interactions, and patient perceptions of recommended treatments. These perceptions could subsequently directly affect patient-treatment decisions. Thus, implicit racial bias is a likely source of racial treatment disparities and must be addressed in oncology training and practice.
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA. pennerl@karmanos.org.
Louis A
LA
Penner
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
John F
JF
Dovidio
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Richard
R
Gonzalez
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Terrance L
TL
Albrecht
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Robert
R
Chapman
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Tanina
T
Foster
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Felicity W K
FW
Harper
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Nao
N
Hagiwara
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Lauren M
LM
Hamel
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Anthony F
AF
Shields
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Shirish
S
Gadgeel
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Michael S
MS
Simon
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Jennifer J
JJ
Griggs
Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
Susan
S
Eggly
D001741:Black or African American; D018912:Arabs / Q000523:psychology; D044466:Asian People / Q000523:psychology; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000628:therapy*; D000072103:Oncologists / Q000523:psychology*; D010817:Physician-Patient Relations; D063505:Racism / Q000523:psychology*; D011897:Random Allocation; D044465:White People / Q000523:psychology