Tackling healthcare provider bias in care and research: A systematic review.

Abstract

e23222 Background: Despite efforts in oncology to provide personalized and patient-centered care, clinical research lacks real-world representation leading to skewed clinical data and unequal health outcomes. Healthcare provider (HCP) bias can be a cause of this uneven inclusion. We conducted a systematic review on interventions addressing HCP bias as part of a larger project aiming to build a toolkit for inclusion and diversity in oncology research. Methods: Scopus, Cochrane, and PubMed (2004-2024) were searched for English-language studies of interventions targeting HCP bias and cultural competence. Data extraction included participant demographics, intervention components, and outcomes. Oncology-focused studies were analyzed separately to explore intervention content and efficacy within this specific field. Results: A total of 104 studies involving 14,296 HCPs were included, 9 of which focused on oncology. Regarding studies conducted in oncology, 90% (8/9) were conducted in the USA, with predominantly white and female participants and primarily aimed to enhance HCPs’ cultural competence or mitigate racial or gender bias. Intervention components included awareness techniques coupled with educational and/or experiential (interactive activities, live experiences and skill building) learning methods. Outcomes assessed explicit bias, cultural competence, knowledge of healthcare disparities, clinical knowledge related to minority groups, and feasibility. While most interventions resulted in significant short-term improvements in cultural competence and knowledge, changes in attitudes and behaviors were less consistent, with lack of long-term efficacy data. All interventions focusing on mitigating clinical trials inclusion bias among HCP’s were conducted in the oncology setting (4/4), with 2 studies yielding promising results on practical outcomes, such as improved clinical trial accrual rates or recruitment practices. In the full dataset, including studies in non-oncology settings, 97 evaluated short-term and 26 long-term efficacy, with positive results in 75% (73/97) and 70% (18/26) respectively, while 35 evaluated qualitative feasibility metrics. In multivariable analysis, HCP category was associated with lower efficacy (non-physicians vs. all HCPs; OR = 0.08, 95% CI 0.01–0.53, p = 0.009), as was work experience ( > 10y vs. less; OR = 0.02, 95% CI 0.00–1.27, p = 0.065 – data available from 40 studies), albeit marginally. Conclusions: This systematic review describes promising results of interventions focused on reducing HCP bias in research and care in the oncology setting. It also provides learnings from other medical fields that could inform future interventions in oncology, including insights on factors associated with lower efficacy. Future studies should apply standardized methods to evaluate short and long-term outcomes, as well as investigate implementation and engagement challenges.