1) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
Ethnographic research has highlighted that that implicit physician bias contribute to disparities observed in whom clinical trials serve. "The Good Study Patient" outlined that physicians judge the patient attributes before offering a trial - are they asking the right questions? are they going to be adherent? will they not only enroll but remain within our trial? Recognizing that physician researchers have mixed priorities, one as physicians they aim to serve patients but as researchers they may aim to recruit and complete their trials. These mixed priorities lead to the physician routinely making judgement calls that are informed by their own bias. This naturally contributes to disparities in trial enrollment. Investigators are now left to explore if automated machine generated trial eligibility reports for patients help to mitigate this contribution to the observed disparities.
2) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
Just to name a few (and there are many!): Need for English proficiency, health literacy, technology (Mychart and accessing a physician); and simply the way that an institution is built (e.g how far are infusion clinics from a clinic site, where are the imaging centers?)
All of the above influence cancer clinical trial enrollment and participation. These issues are particularly salient at UCSF which is geographically very spread out and confusing. Treatment cancer clinical trials tend to be very involved, require multiple appointments for labs, imaging and infusions. Therefore patients have to be able to navigate many sites. Additionally, treatment for cancer (especially for investigational drugs/regimens) tends to require close symptom management therefore being able to engage with providers in a seamless fashion makes a huge difference. For patients with low LEP, health literacy, and limited ability to use online tools for communication, close symptom management can be all the more challenging.