Clinician Bias and Patient Experience in Cancer Genetic Counseling
7 affiliations
- 1Department of Public Health Sciences, University of Virginia, Charlottesville
- 2Department of Biostatistics, Virginia Commonwealth University, Richmond
- 3Department of Statistics and Data Science, Jahangirnagar University, Savar, Dhaka, Bangladesh
- 4Center for Molecular Medicine and Genetics, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
- 5Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
- 6Department of Psychology, Virginia Commonwealth University, Richmond
- 7Department of Pediatrics, Virginia Commonwealth University, Richmond
Abstract
Importance: Genetic counseling helps reduce cancer burden; however, disparities exist in genetic counseling.
Objective: To examine associations between genetic counselor (GC) biases (implicit and/or explicit prejudice and stereotyping) and patient-centered outcomes in cancer genetic counseling.
Design, Setting, and Participants: This is a cohort study of patient-clinician communication during cancer genetic counseling focusing on hereditary cancer risk assessment. GCs and patients completed baseline surveys, video and/or audio-recorded sessions, and postencounter surveys. Data were collected at 2 comprehensive cancer centers in the South and Midwest, from August 3, 2023, to July 30, 2025.
Exposure: At baseline, GCs completed measures of implicit prejudice (Race Implicit Association Test), implicit stereotyping (Medical Cooperativeness Implicit Association Test), explicit prejudice (feeling thermometer), and explicit stereotyping (general and medical-context stereotype subscales).
Main Outcomes and Measures: Patients reported postencounter therapeutic alliance, satisfaction, and decisional conflicts. Differences between Black and White patients were evaluated using Welch t test for continuous variables and χ ² or Fisher exact test for categorical variables. Hypothesis testing was conducted using linear mixed-effects models with GC-specific random effects and intracluster correlation coefficients.
Results: The current analysis included 185 cases with complete clinician baseline, patient baseline, and patient postencounter data. The 185 patients (mean [SD] age, 50.1 [14.0] years; 169 female [91.4%]; 16 male [8.6%]; 83 Black [44.9%]; 102 White [55.1%]) saw 1 of the 15 clinicians (mean [SD] age, 32.2 [9.5] years; 8 certified [53.3%]; 7 trainees [46.7%]). Among Black patients (mean [SD] age, 50.1 [13.6] years; 80 female [96.4%]; 3 male [3.5%]), stronger GC endorsement of explicit medical-context stereotypes favoring White over Black patients was significantly associated with poorer therapeutic alliance ( b [SE], −1.40 [0.37] to −1.54 [0.46]), lower satisfaction ( b [SE], −0.74 [0.27]), and greater decisional conflict ( b [SE], −0.85 [0.27] to −0.91 [0.25]), after covariate adjustment. Among White patients (mean [SD] age, 50.1 [14.4] years; 89 [87.3%] female; 13 [12.7%] male), no biases were significantly associated with outcomes after adjustment ( b [SE], −0.14 [0.49] to −0.48 [0.49]). Explicit medical-context stereotyping was the only factor significantly and consistently associated with racial disparities in patient-centered outcomes ( b [SE], −1.35 [0.49] to −1.93 [0.61]).
Conclusions and Relevance: In this cohort study of cancer genetic counseling, stronger endorsement of medical-context stereotypes favoring White over Black patients was significantly associated with poorer patient-centered outcomes among Black patients. Explicit medical-context stereotypes may contribute to racial disparities in genetic counseling. Interventions should address explicit stereotyping and its role in clinical communication.
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BibTeX
@article{hagiwara2026clinician,
title = {{Clinician Bias and Patient Experience in Cancer Genetic Counseling}},
author = {Nao Hagiwara and Yongyun Shin and Sabina Yeasmin and Erin P. Carmany and Susan Eggly and Shown C. T. Jones and Nadia Harika and Anaya Gorham and John Quillin},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.39990},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855826},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinician Bias and Patient Experience in Cancer Genetic Counseling
AU - Nao Hagiwara
AU - Yongyun Shin
AU - Sabina Yeasmin
AU - Erin P. Carmany
AU - Susan Eggly
AU - Shown C. T. Jones
AU - Nadia Harika
AU - Anaya Gorham
AU - John Quillin
PY - 2026
DA - 2026/10/26
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.39990
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855826
AB - Importance: Genetic counseling helps reduce cancer burden; however, disparities exist in genetic counseling. Objective: To examine associations between genetic counselor (GC) biases (implicit and/or explicit prejudice and stereotyping) and patient-centered outcomes in cancer genetic counseling. Design, Setting, and Participants: This is a cohort study of patient-clinician communication during cancer genetic counseling focusing on hereditary cancer risk assessment. GCs and patients completed baseline surveys, video and/or audio-recorded sessions, and postencounter surveys. Data were collected at 2 comprehensive cancer centers in the South and Midwest, from August 3, 2023, to July 30, 2025. Exposure: At baseline, GCs completed measures of implicit prejudice (Race Implicit Association Test), implicit stereotyping (Medical Cooperativeness Implicit Association Test), explicit prejudice (feeling thermometer), and explicit stereotyping (general and medical-context stereotype subscales). Main Outcomes and Measures: Patients reported postencounter therapeutic alliance, satisfaction, and decisional conflicts. Differences between Black and White patients were evaluated using Welch t test for continuous variables and χ ² or Fisher exact test for categorical variables. Hypothesis testing was conducted using linear mixed-effects models with GC-specific random effects and intracluster correlation coefficients. Results: The current analysis included 185 cases with complete clinician baseline, patient baseline, and patient postencounter data. The 185 patients (mean [SD] age, 50.1 [14.0] years; 169 female [91.4%]; 16 male [8.6%]; 83 Black [44.9%]; 102 White [55.1%]) saw 1 of the 15 clinicians (mean [SD] age, 32.2 [9.5] years; 8 certified [53.3%]; 7 trainees [46.7%]). Among Black patients (mean [SD] age, 50.1 [13.6] years; 80 female [96.4%]; 3 male [3.5%]), stronger GC endorsement of explicit medical-context stereotypes favoring White over Black patients was significantly associated with poorer therapeutic alliance ( b [SE], −1.40 [0.37] to −1.54 [0.46]), lower satisfaction ( b [SE], −0.74 [0.27]), and greater decisional conflict ( b [SE], −0.85 [0.27] to −0.91 [0.25]), after covariate adjustment. Among White patients (mean [SD] age, 50.1 [14.4] years; 89 [87.3%] female; 13 [12.7%] male), no biases were significantly associated with outcomes after adjustment ( b [SE], −0.14 [0.49] to −0.48 [0.49]). Explicit medical-context stereotyping was the only factor significantly and consistently associated with racial disparities in patient-centered outcomes ( b [SE], −1.35 [0.49] to −1.93 [0.61]). Conclusions and Relevance: In this cohort study of cancer genetic counseling, stronger endorsement of medical-context stereotypes favoring White over Black patients was significantly associated with poorer patient-centered outcomes among Black patients. Explicit medical-context stereotypes may contribute to racial disparities in genetic counseling. Interventions should address explicit stereotyping and its role in clinical communication.
SN - 2574-3805
ER -