Making Cancer Care Equitable: A Conversation Between Dr. Marilyn Fraser and Dr. Joseph Ravenell

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Provider bias, the conscious or unconscious prejudices medical providers hold when treating patients, has been brought to the forefront of conversations regarding cancer treatment equity. These biases can affect the types of treatment and resources afforded to patients from different backgrounds. Ongoing efforts to raise community awareness and healthcare provider education of these issues can contribute to improved patient outcomes. Dr. Marilyn Fraser of the Arthur Ashe Institute for Urban Health and Dr. Joseph Ravenell from NYU Langone Health’s Perlmutter Cancer Center discussed these efforts in the recent Close the Gap event.

“When we talk about provider bias, oftentimes we don't recognize that we all come to the table with our own biases and prejudices that we may have," says Dr. Fraser. "And it's important for us to recognize these implicit biases that we come and present with so that we are better equipped to deal with patients, community members, and people who come for care."

RELATED: Provider Bias in Healthcare: How To Change The Dynamic

Whether biases manifest themselves through race, socioeconomic class, or personal preconceptions, provider biases have real impacts on the types of treatment different patients receive. In a New England Journal of Medicine study from 1999, the authors presented 720 physicians with actors representing patients of different races and sexes with the same set of scripted symptoms regarding chest pain. The study found that black women were significantly less likely to be recommended treatment for severe disease than white men, suggesting that the standard of treatment between various patient populations was significantly skewed. Even though more than two decades have passed, this bias has persisted within our healthcare systems and should be re-examined in the present context.

"These implicit biases are something that we can actually do something about. Increasing our awareness of these biases has been shown to actually demonstrate that we can check those biases once we are aware of them," adds Dr. Ravenell. "I think it's important for us to keep in mind that provider bias is a definite and measurable cause of the health disparities that we see, including those in cancer health."

Health disparities are common in cancer screenings, which are proven to improve patient outcomes. Dr. Fraser and Dr. Ravenell have worked closely together to educate communities and dispel myths specifically regarding colorectal cancer screening. In addition, they try to ensure that neighborhoods have access to not only screening resources but also quality healthcare so that people receive the best care possible.

"We have to be advocates for our own health; we have to be advocates for the health of others. We do not live in a system by ourselves or in bubbles," says Dr. Fraser.

Yet distrust in communities can be a barrier for members to seek out screening resources, especially in Black and Latinx communities.

"Traditionally there were historic issues within our country and culture that we cannot negate. There were atrocities committed against people of color when it came to research and science. So to build trust, we need to engage with those communities," says Dr. Fraser. "We need to come from a place of education and a place of acknowledgment of the past so that we can improve the future.”

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Sophia Li is a writer for SurvivorNet who is passionate about narrative medicine and sharing patient stories. Read More

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