Targeting Bias to Reduce Disparities in End of Life Care

Study 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.

Primary Outcome

Verbal dominance was determined by the ratio of clinician to caregiver speaking time during the encounter, ranging from a minimum of 0 to a maximum of approximately 3. A ratio of \>1 indicates that the clinician dominated the discussion. Ratio of clinician to caregiver speaking times are expressed as decimals and summarized both prior to and following the intervention by study arm.

Interventions

• BEHAVIORAL Communication skills training
• BEHAVIORAL Communication and Bias Mitigation Training