Cancer Clinical Trial Participant Selection: Does Provider Implicit Bias Play a Role?

The underrepresentation of minority groups in cancer clinical trials limits understanding, access to treatments, and increases health disparities. Biases can influence their decision to offer clinical trials, resulting in lower enrollment of these populations. The study investigates patient feelings of discrimination and implicit biases that may affect discussions about clinical trials.

The study was conducted at an urban cancer center involving 171 patients undergoing cancer treatment and 28 oncologists. Providers completed the Implicit Attitudes Test (IAT)-Compliant test and a survey about their assumptions about patients. Patients answered questions regarding clinical trial discussions, experiences of discrimination, the patient/provider relationship, communication, and trust. Univariable analyses compared non-Hispanic White (NHW) patients with patients of other racial/ethnic backgrounds.

Many providers (88.4%) showed a moderate preference for NHW patients as compliant; 47.6% of patients reported having a clinical trial conversation; 22% enrolled. Two-thirds (67.9%) of providers acknowledged making assumptions based on patient characteristics which most patients underestimated. Other than NHW patients more often than NHW reported feelings of discrimination and mistrust including not being heard by their provider (p 0.021), provider acted as if better (p = 0.001) and experiments are conducted without patient knowledge (p = 0.008).

Our findings support that healthcare providers tend to view NHW patients as more compliant than other racial/ethnic groups, which may affect their clinical behavior. These findings emphasize the need for further investigation into these interpersonal dynamics and calls for a shift in focus to patient experiences and provider interactions to address underrepresentation in clinical trials.