Many studies have shown the negative effect health providers’ underlying prejudices can have on the doctor-patient relationship and the decisions patients make about their care. And according to a new study, oncologists are not immune.
Some cancer physicians are letting their implicit racial biases get in the way of quality treatment for Black patients.
Researchers at the Karmanos Cancer Institute in Detroit, Michigan, studied video-recorded interactions between 18 non-Black medical oncologists and 112 of their new African-American patients to see whether the doctors’ unconscious beliefs might come into play. The scientists took notes during the sessions at Detroit-area cancer hospitals, rating the doctors’ bedside manner and tracking the length of the meeting, including the amount of time doctors and patients spoke.
Patients filled out a survey following the appointment, which asked questions about the physician’s communication skills as well as the participants’ level of distress, trust and feelings about the suggested treatment options.
The findings, published June 20 in the Journal of Clinical Oncology, revealed that oncologists who had previously tested higher for implicit racial bias spent less time with their patients, leaving them unsatisfied and often unable to remember what was discussed during the meetings. African-American patients rated those doctors’ communications as less patient-centered and supportive and reported less confidence in recommended treatments. The patients also perceived the treatments as being more difficult to get through.
“The surprising part to me is that black cancer patients, in the midst of all the other things they must be thinking as they deal with their cancer, can detect this bias in the behavior of their physician,” Louis A. Penner, lead author of the study, told Reuters. “If you think your physician doesn’t care about you and/or you can’t trust them, this almost certainly affects how much confidence you have in his/her treatment recommendations.”
Reuters reports the majority of oncologists were male, while most of the patients were women. An implicit bias test administered several weeks before the sessions began showed that doctors’ levels were generally lower than the national average but similar to those found in Detroit.
According to the Office of Minority Health, Black Americans have the highest mortality rate of any racial and ethnic group for all cancers combined.
Although African-American women were 10 percent less likely to have been diagnosed with breast cancer in 2011, they were nearly 40 percent more likely to die from the disease than white women.
And African-American men are 2.3 times as likely to die from prostate cancer than white men.
Last October, a JAMA Oncology study found that older Black men with prostate cancer were more likely to receive lower quality, yet more expensive health care than white men.
The elderly men had more complications following prostate removal surgery that were associated with higher costs, according to Quoc-Dien Trinh, lead researcher and an assistant professor of surgery at Harvard Medical School, who said the results called into question the notion that African-Americans are genetically predisposed to the cancer.
“My interpretation is that all this talk about Blacks having more biologically aggressive disease and hence worse survival may in fact be more of an access to care or access to treatment problem,” Trinh said in an email to Reuters.
Even young people face racial disparities in cancer diagnoses and death rates.
A recent study from the University of Colorado Cancer Center found that Black and Hispanic people between the ages of 15 and 29 are nearly 75 percent more likely to die from liver cancer than whites of the same age. The disproportionate rates were the same for cancers such as soft tissue sarcomas, lymphomas, leukemia, and germ cell tumors.