Clinician Bias and Patient Experience in Cancer Genetic Counseling

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 χ2 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.