The social and behavioral influences (SBI) study: study design and rationale for studying the effects of race and activation on cancer pain management

Cezanne M Elias, Cleveland G Shields, Jennifer J Griggs, Kevin Fiscella, Sharon L Christ, Joseph Colbert, Stephen G Henry, Beth G Hoh, Haslyn E R Hunte, Mary Marshall, Supriya Gupta Mohile, Sandy Plumb, Mohamedtaki A Tejani, Alison Venuti, Ronald M Epstein, Cezanne M Elias, Cleveland G Shields, Jennifer J Griggs, Kevin Fiscella, Sharon L Christ, Joseph Colbert, Stephen G Henry, Beth G Hoh, Haslyn E R Hunte, Mary Marshall, Supriya Gupta Mohile, Sandy Plumb, Mohamedtaki A Tejani, Alison Venuti, Ronald M Epstein

Abstract

Background: Racial disparities exist in the care provided to advanced cancer patients. This article describes an investigation designed to advance the science of healthcare disparities by isolating the effects of patient race and patient activation on physician behavior using novel standardized patient (SP) methodology.

Methods/design: The Social and Behavioral Influences (SBI) Study is a National Cancer Institute sponsored trial conducted in Western New York State, Northern/Central Indiana, and lower Michigan. The trial uses an incomplete randomized block design, randomizing physicians to see patients who are either black or white and who are "typical" or "activated" (e.g., ask questions, express opinions, ask for clarification, etc.). The study will enroll 91 physicians.

Discussion: The SBI study addresses important gaps in our knowledge about racial disparities and methods to reduce them in patients with advanced cancer by using standardized patient methodology. This study is innovative in aims, design, and methodology and will point the way to interventions that can reduce racial disparities and discrimination and draw links between implicit attitudes and physician behaviors.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT01501006" title="See in ClinicalTrials.gov">#NCT01501006, November 30, 2011.

Keywords: Cancer; End of life care; Field experiment; Implicit bias; Pain management; Palliative care; Patient-centered communication; Racial disparities; Randomized clinical trial; Standardized patients.

Conflict of interest statement

Ethics approval and consent to participate

This study has been approved by the Purdue University IRB (1009009643), the University of Rochester Research Subjects Review Board (RSRB00033086), the University of Michigan Human Research Protection Program (HUM00067842), and McClaren Health Care Corporation, Human Research Protections Program (2014–00098). All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Fig. 1
Conceptual model

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