A new report discusses disparities in outcomes for Black survivors of cancer compared with those of White survivors, in the context of decision-making in the patient care setting. This report was published in the Clinical Journal of Oncology Nursing.

The report, authored by Jacqueline B. Vo, PhD, RN, MPH, of the National Cancer Institute in Bethesda, Maryland, and colleagues, addressed biases that may be present in care and provided suggestions to mitigate health disparities. The authors noted that survival outcomes are often worse for Black patients than for other patients, which may be the result of differences in health care received. They described multiple types of decision-making biases that may impact clinical care.

Implicit bias involves negative thoughts or sentiments toward a patient group that are not conscious in nature. One example was a possible belief that patients from a certain group may not be able to afford fertility preservation, and thus the option is not discussed.

Continue Reading

Default bias concerns decision-making based on a default choice or to maintain a status quo. An example is the use of nonopioid pain management as a default approach, even when it may not be the most effective method, because of a desire to reduce the number of opioid prescriptions.

Delay discounting bias is a form of bias in which immediate results become favored over longer-term results. This could include use of a treatment known to potentially cause infertility but without attempting fertility preservation first.

Availability bias occurs when greater familiarity with certain outcomes lead a care provider to think of other conditions less often. This could influence perceptions of risks related to other diseases.

“Although these cognitive biases are not directly related to race, some research suggests that people may be more likely to use cognitive heuristics when making decisions about outgroup (eg, those outside one’s racial, ethnic, gender, or nationality group) compared to ingroup members,” Dr Vo and colleagues wrote in their report. Biases also may factor into communication with patients regarding treatment effects, which may influence decision-making.

To reduce health disparities in treatment-related adverse effects, Dr Vo and colleagues suggested approaches such as providing culturally appropriate care with attention to an inclusive environment and engagement in practices and behaviors that are favorable to the health of Black patients.

Assessment of health literacy also was recommended to reduce health disparities and aid patients with voicing their preferences related to treatment. Oncology nurses should monitor for adverse effects with treatment; oncology nurse navigators can assist with education and other resources to aid with decision making and care.

“Oncology nurses can ensure that patients understand the major adverse effects and that the patients’ wishes, particularly Black patients who are disproportionately affected by cancer, are heard and met,” the authors stated in their conclusion.


Vo JB, Gillman A, Mitchell K, Nolan TS. Health disparities: impact of health disparities and treatment decision-making biases on cancer adverse events among Black cancer survivors. Clin J Oncol Nurs. 2021;25(5):17-24. doi:10.1188/21.CJON.S1.17-24