Is Implicit Bias Behind Racial Disparities in Treatment Recommendation?

Unconscious, implicit bias towards Black patients may be the central factor influencing racial disparities in provider recommendations for certain treatment options, such as the removal of brain tumors, according to a recent study by University of Minnesota Medical School researchers. 

An extensive amount of research has emphasized a variety of racial disparities within surgical care, from patient outcomes to patient access to those procedures.

Researchers highlighted that Black patients are known to have higher mortality rates after common abdominal procedures, lower survival rates in transplant surgery, and higher rates of in-hospital complications and disease recurrence in multiple surgical subsets.

Additionally, separate studies have shown that even within the same hospital, Black patients are more likely than White patients to experience adverse patient safety events related to surgical care.

These racial disparities in surgical care are caused by multiple factors during a patient's healthcare trajectory, including care access, affordability, and the patient-provider relationship.

However, the researchers pointed out that one of the most difficult factors to consider is the role that implicit bias has on surgical disparities.

The research team examined more than 600,000 patients with intracranial tumors to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors.

According to study findings, Black patients were more likely to receive provider recommendations against surgical removal of several primary brain tumors, including meningioma, glioblastoma, pituitary adenoma, and vestibular schwannoma. Researchers noted that these racial disparities were independent of clinical and demographic factors such as tumor characteristics, comorbidities, insurance status, and rural-urban continuum.

Notably, instances of disparities in surgical recommendations within this study were seen for Hispanic and Asian or Pacific Islander patients who had higher odds of recommendation against surgery for glioblastoma, which persisted after controlling for insurance status. 

These results highlight a concern for bias in treatment recommendation and provide a basis for future studies to gain further insight into unrecognized bias in clinical decision-making.

“Racial disparities have existed historically throughout health care, but are often attributed to socioeconomic inequities,” Andrew Venteicher, MD, PhD, an assistant professor of neurosurgery at the U of M Medical School and neurosurgeon with M Health Fairview, said in a press release.

“New data collection and analysis techniques allow us to control for these factors and start to look at whether bias is happening at a provider level,” said Venteicher, who is also a Masonic Cancer Center member. “Clearly, more work is needed to identify these biases and educate providers on how to address them.”

The stark racial health disparities driven by implicit bias in medicine can be offset by patient activation.

Jennifer Griggs, MD, MPH, a professor of hematology and oncology at the University of Michigan Medical School and of health management and policy at the U-M School of Public Health, suggested that patient activation is a promising tool against the complexities of implicit bias in medicine.

“What we found was that activating the patients to ask questions, to interrupt when necessary to make sure their needs were met, overrode the patterns of care and biases that physicians may hold about expected patient behaviors,” Griggs stated.