Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?

<h4>Rationale</h4> Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field expe...

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Autores principales:	Kevin Fiscella, Ronald M. Epstein, Jennifer J. Griggs, Mary M. Marshall, Cleveland G. Shields
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7f9a1964aca844038fcd0275cbb3fec6
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spelling	oai:doaj.org-article:7f9a1964aca844038fcd0275cbb3fec62021-11-04T06:49:46ZIs physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?1932-6203https://doaj.org/article/7f9a1964aca844038fcd0275cbb3fec62021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8550362/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Rationale</h4> Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field experiment. <h4>Methods</h4> We conducted an analysis of a randomized field experiment between 2012 and 2016 with 96 primary care physicians and oncologists using unannounced, Black and White standardized patients (SPs)who reported uncontrolled bone pain from metastatic lung cancer. We assessed implicit bias using a pain-adaptation of the race Implicit Association Test. We assessed clinical care by reviewing medical records and prescriptions, and we assessed communication from coded transcripts and covert audiotapes of the unannounced standardized patient office visits. We assessed effects of interactions of physicians’ implicit bias and SP race with clinical care and communication outcomes. We conducted a slopes analysis to examine the nature of significant interactions. <h4>Results</h4> As hypothesized, physicians with greater implicit bias provided lower quality care to Black SPs, including fewer renewals for an indicated opioid prescription and less patient-centered pain communication, but similar routine pain assessment. In contrast to our other hypotheses, physician implicit bias did not interact with SP race for prognostic communication or verbal dominance. Analysis of the slopes for the cross-over interactions showed that greater physician bias was manifested by more frequent opioid prescribing and greater discussion of pain for White SPs and slightly less frequent prescribing and pain talk for Black SPs with the opposite effect among physicians with lower implicit bias. Findings are limited by use of an unvalidated, pain-adapted IAT. <h4>Conclusion</h4> Using SP methodology, physicians’ implicit bias was associated with clinically meaningful, racial differences in management of uncontrolled pain related to metastatic lung cancer. There is favorable treatment of White or Black SPs, depending on the level of implicit bias.Kevin FiscellaRonald M. EpsteinJennifer J. GriggsMary M. MarshallCleveland G. ShieldsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Kevin Fiscella Ronald M. Epstein Jennifer J. Griggs Mary M. Marshall Cleveland G. Shields Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
description	<h4>Rationale</h4> Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field experiment. <h4>Methods</h4> We conducted an analysis of a randomized field experiment between 2012 and 2016 with 96 primary care physicians and oncologists using unannounced, Black and White standardized patients (SPs)who reported uncontrolled bone pain from metastatic lung cancer. We assessed implicit bias using a pain-adaptation of the race Implicit Association Test. We assessed clinical care by reviewing medical records and prescriptions, and we assessed communication from coded transcripts and covert audiotapes of the unannounced standardized patient office visits. We assessed effects of interactions of physicians’ implicit bias and SP race with clinical care and communication outcomes. We conducted a slopes analysis to examine the nature of significant interactions. <h4>Results</h4> As hypothesized, physicians with greater implicit bias provided lower quality care to Black SPs, including fewer renewals for an indicated opioid prescription and less patient-centered pain communication, but similar routine pain assessment. In contrast to our other hypotheses, physician implicit bias did not interact with SP race for prognostic communication or verbal dominance. Analysis of the slopes for the cross-over interactions showed that greater physician bias was manifested by more frequent opioid prescribing and greater discussion of pain for White SPs and slightly less frequent prescribing and pain talk for Black SPs with the opposite effect among physicians with lower implicit bias. Findings are limited by use of an unvalidated, pain-adapted IAT. <h4>Conclusion</h4> Using SP methodology, physicians’ implicit bias was associated with clinically meaningful, racial differences in management of uncontrolled pain related to metastatic lung cancer. There is favorable treatment of White or Black SPs, depending on the level of implicit bias.
format	article
author	Kevin Fiscella Ronald M. Epstein Jennifer J. Griggs Mary M. Marshall Cleveland G. Shields
author_facet	Kevin Fiscella Ronald M. Epstein Jennifer J. Griggs Mary M. Marshall Cleveland G. Shields
author_sort	Kevin Fiscella
title	Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
title_short	Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
title_full	Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
title_fullStr	Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
title_full_unstemmed	Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
title_sort	is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/7f9a1964aca844038fcd0275cbb3fec6
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Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?

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