Racial/Ethnic Biases and Stereotypes Among Research and Clinical Professionals

In a study of research and clinical professionals published in Cancer, researchers found that not only did some respondents view racial and ethnic minorities as less promising study participants, some respondents also reported withholding trial opportunities from minorities based on these perceptions. 

Some providers also backed using tailored recruitment strategies, whereas others eschewed race as a factor in trial recruitment. Given these findings, the presence of bias and stereotyping among these professionals should be considered when designing interventions to increase minority enrollment.

“Despite the best intentions to provide equal clinical trial access to all patients, disparities in clinical trial participation persist and may lead to unacceptable increases in morbidity and mortality for some individuals,” the authors wrote. “Herein, we have suggested that bias may impede the willingness of some clinical and research professionals to offer clinical trial enrollment and may explain, in part, variations in participation in cancer clinical trials.”

Researchers conducted a total of 91 qualitative interviews at 5 US cancer centers across 4 stakeholder groups, including cancer center leaders, principal investigators, referring clinicians, and research staff. They then conduced data analysis using a content analysis approach to produce themes from the transcribed interviews. 

From the interviews 5 prominent themes emerged, including:

• Recruitment interactions with potential minority participants were perceived to be challenging.

• Potential minority participants were not perceived to be ideal study candidates.

• A combination of clinic-level barriers and negative perceptions of minority study participants led to providers withholding clinical trial opportunities from potential minority participants.

• When clinical trial recruitment practices were tailored to minority patients, addressing research misconceptions to build trust was a common strategy.

• For some respondents, race was perceived as irrelevant when screening and recruiting potential minority participants for clinical trial. 

“The potential denial of opportunities to participate based on the racial prejudices of professional stakeholders could directly hinder efforts to elucidate the underlying mechanisms explaining poorer cancer clinical outcomes in many racial and ethnic minorities compared with white individuals,” the authors wrote. 

Notably, the researchers indicated that the referring physicians were generally more likely to express racial stereotypes compared with other stakeholder groups. Additionally, the data was collected in 2010, and it is possible that the professional perspectives have changed over time. 

In order to combat the inherent biases and stereotypes involved in recruiting and retaining racial minority patients in clinical trials, the authors recommended adopting an interventional framework originally intended for medical trainees and practicing physicians to prevent unconscious racial attitudes and stereotypes from negatively affecting the course and outcomes of clinical encounters. 

“These strategies and skills are designed to: 1) enhance internal motivation to reduce bias while avoiding external pressure; 2) increase understanding about the psychological basis of bias; 3) enhance providers’ confidence in their ability to successfully interact with socially dissimilar patients; 4) enhance emotional regulation skills; and 5) improve the ability to build partnerships with patients,” the authors wrote.

Reference:

Niranjan SJ, Martin MY, Fouad MN, et al. Bias and Stereotyping Among Research and Clinical Professionals: Perspectives on Minority Recruitment for Oncology Clinical Trials. Cancer. doi:10.1002/cncr.32755.