Targeting Bias to Reduce Disparities in End of Life Care

Summary

This study aims to determine the ways in which clinician implicit racial biases affect clinician communication with family members of patients near the end of life and to test a novel physician training intervention to reduce the effects of implicit racial bias on quality of communication.

Phase 1:

A sample of 50 physicians who care for seriously ill patients, including oncologists, critical care physicians and hospital-based internists will participate in a simulated clinical encounter with a Black standardized family member (actor) of a hypothetical case patient. Measures of implicit and explicit bias will be correlated with verbal and nonverbal communication behavior.

Phase 2:

This is a 2-arm randomized feasibility pilot of an intervention to mitigate the effects of clinician implicit bias on communication behavior. Physicians who treat patients with serious illness including oncologists, critical care physicians and hospital-based internists will be recruited to participate in a communication training session to reduce the effects of implicit bias or a control training session focusing only on communication skills. Their communication behavior will be videotaped during a simulated encounter with a Black standardized family member (actor) of a hypothetical patient with serious illness before and after the training sessions. The communication behavior before and after the training session will be compared between physicians that received the communication skills only intervention versus the physicians that received the communication skills and bias mitigation training.

The primary hypothesis is that physicians who receive both the communication skills and the bias mitigation training will have greater improvements in communication skills with the Black standardized caregiver (actor) compared with those who receive only the communication skills training.

This registration is inclusive of phase 2 only as phase 2 is the clinical trial portion of this research. Phase 1 is not a clinical trial as it was an observational study that did not include an intervention. Phase 1 data was used to inform the structure and analysis of phase 2.

Conditions

• Terminal Illness
• Critical Illness

Interventions

BEHAVIORAL

Communication and Bias Mitigation Training

Training to improve communication skills and reduce the effect of racial bias on clinician communication behavior

BEHAVIORAL

Communication skills training

Training to improve communication skills between physicians and caregivers.

Sponsors & Collaborators

• National Institute on Minority Health and Health Disparities (NIMHD)

  collaborator NIH

• University of Nebraska Lincoln

  collaborator OTHER

• Tulane University School of Medicine

  collaborator OTHER

• Dartmouth College

  collaborator OTHER

• Montefiore Medical Center

  lead OTHER

Principal Investigators

• Elizabeth Chuang, MD · Montefiore Medical Center/Albert Einstein College of Medicine

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2022-02-03

Primary Completion

2024-11-01

Completion

2024-11-01

Countries

• United States

Study Locations