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Implicit bias in treatment impacts clinical trials too

By Ash Rishi

Ash RishiWe all have our own opinions based on influences over the years and can be biased towards them when making decisions, without considering other possibilities. More often than not, it doesn’t come from a place of bad intent and normally wouldn’t cause an issue in our everyday lives. However, it starts to become an issue when bias is found in clinical trials, from protocol development to site choice and patient recruitment strategies.

In short, bias exists in many forms – implicit, racial, gender, age bias and more.

Why we need to remove implicit bias
Patients should not expect to receive a lower standard of care due to their race, ethnicity, age, gender or any other characteristic. However, there is a lot of evidence that shows this is happening and that unconscious bias exists in healthcare today.

Maybe it’s a case of patients receiving a bit more time and attention if their healthcare provider relates well to them. Or maybe investigators are unintentionally speaking to some patients differently, because of their beliefs about social class. The truth is, it might not be intentional, but people can be treated differently based on their gender, the colour of their skin, their age or socio-economic status, rather than being seen as individuals.

As a result, some people can receive different types of tests or treatment based on assumptions. For example, HCPs can put too much focus on patients’ family histories, due to their implicit bias regarding ethnicity and hereditary diseases, rather than being focused on the patient’s individual health status and personal medical history.

The bias of HCPs could affect patient recruitment in clinical trials due to their assumption that certain patients would not want to take part. Or bias from study sponsors or those who are creating the patient recruitment materials could lead to a lack of inclusive patient- facing materials in clinical trials or cultural considerations, such as producing the materials in other languages. This implicit bias can affect patient outreach and result in a lack of diversity in communities. As a result, those who take part in clinical trials are not representative of every race and culture, which means we can’t be sure that the treatments will be safe and effective for everyone.

In short, people’s health outcomes are affected by HCPs’ biases. And as societies become more and more diverse, HCPs will need to effectively communicate with and provide care for patients whose ethnic or cultural background may be different from their own.

We need to take a different approach, encourage a different way of thinking and help change people’s perspectives. Because if this implicit bias continues to exist, so will health disparities across different populations.

How to remove implicit bias
Acknowledge it
The first step is to simply acknowledge that bias exists. Make the unconscious, conscious. Talk about it and raise awareness.

For example, did you know that one study found over 80% of healthcare workers often or sometimes found it more difficult to engage with or treat patients from cultures different from their own? Sharing this statistic will raise awareness in itself, showing that HCPs are not alone in this and that we need to come together to address it.

Report issues and show accountability
There might be a place where people can share their negative experiences and report issues, like filling in a survey. But that survey should be followed up, showing accountability and actions towards a resolution.

Improve education and experience
Perhaps if people were more aware of cultural and individual differences earlier on, this could help to alleviate bias in the future. For example, medical and nursing schools could include communicating with people from different backgrounds on the curriculum and students could experience spending time with minority communities to gain a better understanding of health inequities.

Consider cultural safety training
Cultural safety training allows people to evaluate and critique their individual attitudes, biases, stereotypes and more. It aims to help people become more self-aware and communicate effectively with all types of people, to ultimately provide equal care to everyone.

When we start to see people as individuals and understand that everyone is different, we can communicate more effectively with all ethnicities, genders, ages and more, to ultimately improve patient recruitment in clinical trials and ensure better health for all.

Ash Rishi is CEO and Co-founder of COUCH Health

12th December 2022

From: Research, Marketing


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