In this EPEP segment, Dr. Demetria Smith-Graziani from Emory University School of Medicine and Dr. Folasade May from UCLA Health discuss how structural inequities and provider bias influence everyday oncology practice, from clinical decision-making to communication and access to treatment innovations.
Through real-world examples, they illustrate how assumptions about patients’ interests, understanding, or ability to adhere to treatment can lead to unequal clinical trial offers, incomplete information-sharing, and disparate care recommendations, even within the same clinic.
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Transcript
Dr. Nicole Rochester:
Dr. Smith-Graziani, how do structural inequities and provider bias show up in everyday practice, because we know that those also contribute to the disparities. And then what are actionable steps that clinicians can take to counter these as treatment innovations evolve?
Dr. Demetria Smith-Graziani:
Yeah, another great question, because, you know, when we talk about these big, you know, policies, these historical factors, sometimes it feels a little bit overwhelming for an individual provider to say, well, what can I do? And, you know, on the larger level, you can advocate for policy changes, you can make sure that your healthcare organization has appropriate support services, to help patients navigate, and you can work with community organizations. But on a day-to-day level, an encounter with patients, I think one of the biggest barriers, that has been identified is, providers assuming who is going to be interested in a clinical trial, who is going to be interested in a particular treatment, and because of that, they may just not ask.
Like, the research has really shown that there are just disparities, And who the same provider is going to ask about a clinical trial. And so there actually has been training underway at Emory and other organizations, with the goal of educating providers and encouraging them to really just ask every patient about clinical trials, because you may be surprised by who may have an interest. And I think we also get to that point of being able to ask about their interests and getting the appropriate treatment for someone by building rapport, right? We’re building trust with patients.
Patients are going to be more likely to open up and ask questions if they feel like they can trust you, and so I think it’s really important that we encourage questions from patients, that we explain the reasoning behind recommendations, and oftentimes we have to, I know in an initial oncology visit, we’re giving out a lot of information, it can be very overwhelming, and sometimes people get into a habit of delivering these recommendations without really explaining a why behind them and just because patients don’t have the specific medical training doesn’t mean that they can’t understand why a treatment applies to them. You just meet patients where they are, you give them the plain language, you develop that collaborative relationship, you respect their autonomy, and then from there, you can provide that additional knowledge that allows them to make their informed decision.
Dr. Nicole Rochester:
Thank you. Thank you so much, Dr. Smith-Graziani. Dr. May, do you have anything that you’d like to add to that?
Dr. Folasade May:
No, I love that answer, and I think what we see a lot of times, especially when we look at things like treatment disparities, we have patients who are Black patients, for example, and patients who are white patients, they’re walking into the same provider’s office, and they’re getting different information.
And I think what’s happening is that we as providers sometimes think, maybe this patient can’t handle this level of information or make these decisions for themselves. We can’t make those assumptions, those are biases that have built into our society, historically and over time, from the commercials we see, the movies we watch, even the medical training we’ve received, and we need to break away from that. We need to make sure that we’re providing patients with all of the information, helping them understand, maybe some patients need additional support, but it’s really our job to make sure we’re conveying all the options, whether it’s trials, or other treatment options, and letting patients and their families make the choice that’s best for them, instead of assuming.
Dr. Nicole Rochester:
Absolutely. I really appreciate both of you holding that up, because I think because so much of medicine now is based on protocols and their algorithms, many of us assume that we’re giving the same care to all of our patients, and you both have elucidated that, in fact, that is not always the case.