Understanding Implicit Bias and Its Impact on Oncology Care

By Stephanie DeMeyer, MA, Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - January 3, 2023

An implicit bias is an “unconscious association, belief, or attitude toward any social group.” Everyone has implicit biases, including health care teams. For oncology nurses, however, biases can affect patient care. Stephanie L. Graff, MD, FACP, spoke at the 2022 Academy of Oncology Nurse & Patient Navigator (AONN+) national meeting to emphasize the critical role of oncology nurses in identifying and addressing implicit bias instead of avoiding it.

Definition of Implicit Bias

Implicit biases were an essential evolutionary tool for early survival. For example, if a neighbor ate red berries and grew ill, then all red fruits (like tomatoes) might be categorized as poisonous – in fact, early Americans thought as much until Thomas Jefferson proved otherwise. Unfortunately, this trait carries over to people as well. Someone might have a preference or aversion to a person or group of people or may believe that the group holds specific characteristics.

These thoughts and feelings are implicit if the person is unaware of them or mistaken about their nature. Therefore, “implicit bias” describes attitudes toward people or associated stereotypes without conscious knowledge, explained Dr. Graff. Biases may also be explicit, where the person is aware of the prejudices and attitudes.

Implicit Bias Impact

Dr. Graff emphasized how implicit bias can harm patients and team. She shared information on its negative impact.

Patient Impact. Examples of the real-world impact of bias were presented at the Trust in Science and Healthcare panel discussion at the 2021 San Antonio Breast Cancer Symposium.

Black women are told to “see what progresses”; White women have biopsy within 24-48 hours
Black women are told biopsy results over the phone; White women are given results in the office
Black women have a 40% higher death rate from breast cancer

Team Impact. Dr. Graff explained that “racial discrimination is an emerging risk factor for disease, decreasing the health of the care team. Furthermore, harassment impacts commitment, tardiness, absenteeism, job performance, turnover, and burnout.”

Unconscious Stereotypes

Unconscious stereotypes can appear in relationships among care team members and in patient relationships. With implicit bias, Dr. Graff said, “everyone thinks about racial and gender bias, but there are so many others.” Other examples she shared included:

Age bias
Disability bias
Gender bias
Parenting bias
Political leanings bias
Racial bias
Religious bias
Sexual and gender minority bias
Vaccine status bias
Vietnam veteran status bias
Weight bias

She cautioned oncology nurses that these are biases in the United States, and other countries or cultures may have different biases. Implicit bias can take other forms, such as color bias, cultural bias, caste or socioeconomic status bias, and foreign language bias. In addition, people can have a bias against someone based on their clothing, beauty, hair, or accent.

Mitigating Implicit Bias

Everyone has implicit biases that are outside of their conscious awareness. The first step to overcoming implicit bias is to identify it. Dr. Graff recommends the “practice makes perfect” motto, so explore and determine your prejudices by taking implicit association tests, such as the ones offered from Harvard University. Dr. Graff emphasized that doing these tests can reveal how your biases could influence your thinking.

Oncology nurses can help mitigate implicit bias by identifying and evaluating their own. Be intentional about spending time with people different from yourself to help reduce subconscious stereotypes. Change your routine. Consider volunteering, joining a book club, or participating in cultural celebrations. Your proactive steps can lead to closing gaps in health equity.