ArticlePloS one2021
Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- A Systematic Review of Interpersonal Interactions Related to Racism in Studies Assessing Breast and Gynecological Cancer Health Outcomes Among Black Women.Journal of racial and ethnic health disparities · 2024Pooled it
- A Brief Online Implicit Bias Intervention for School Mental Health Clinicians.International journal of environmental research and public health · 2022Trial
- Physician Implicit Racial Bias and Guideline-Concordant Vascular Care.JAMA network open · 2026Article
- Large language models perpetuate bias in palliative care: Development and analysis of the Palliative Care Adversarial Dataset (PCAD).PLOS digital health · 2026Article
- Patient-reported postoperative pain and stigmatizing language in anesthesia notes: a cross-sectional study (2017-2019).International journal of obstetric anesthesia · 2026Article
- Speaking Out: Factors Influencing Black Americans' Engagement in COVID-19 Testing and Research.Journal of racial and ethnic health disparities · 2026Article
- Ethnic disparities in opioid prescribing for cancer pain and associated emergency department visits and hospital admissions in the last three months of life: a retrospective cohort study.British journal of cancer · 2025Article
- Critical Self-reflection on Racism by Hospital Physicians in Large German Cities. A Qualitative Reconstructive Study Using Episodic Interviews.Journal of racial and ethnic health disparities · 2025Article
- Inequalities in Access to Specialist Allergy Services in the United Kingdom: A Report From the BSACI Registry for Immunotherapy (BRIT).Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2025Article
- Toward equitable regenerative medicine: a health equity research framework for emerging regenerative treatments.Regenerative medicine · 2025Review
- Examining the Impact of Race and Sex on the Incidence of Positive Surgical Margins in Oral Cavity Squamous Cell Carcinoma.Head & neck · 2025Article
- Shared decision making in routine oncology appointments with Black patients with lung cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Observational
- Modern racism contributes to overall less pain management and a "one size fits all" approach.Health psychology report · 2025Review
- The contribution of nonmedical opioid use to healthcare encounters for opioid overdose and use disorders among long-term users with metastatic cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- Racial discrimination and health-care system trust among American adults with and without cancer.Journal of the National Cancer Institute · 2024Article
- "If we don't speak the language, we aren't offered the same opportunities": Qualitative perspectives of palliative care access for women of color living with advanced breast cancer.SSM. Qualitative research in health · 2024Article
- Race and Ethnicity Are Related to Undesirable Home Health Care Outcomes in Seriously Ill Older Adults.Journal of the American Medical Directors Association · 2024Article
- Article
- Racial bias in perceptions of children's pain.Journal of experimental psychology. Applied · 2024Article
- The Water Surrounding the Iceberg: Cultural Racism and Health Inequities.The Milbank quarterly · 2023Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
rationaleImplicit 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.
methodsWe 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.
resultsAs 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.
conclusionUsing 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.