Studies show that minority patients with breast cancer are 50% to 65% less likely than white patients to get genetic testing, even if it is free or covered by insurance. Genetic testing is the first step in precision oncology – individualizing treatments based on a person’s hereditary risk or the molecular characteristics of their cancer. A doctor’s recommendation is a singular predictor of whether patients get genetic counseling and testing, surpassing even cost, culture, and patient attitudes. Today, we must reimagine how to help doctors make sound clinical decisions to achieve precision oncology’s north star: “the right treatments, at the right time, every time to the right person.”
There could be many reasons for why the doctor never spoke with the Black woman about genetic testing. Perhaps the doctor was running behind schedule that day, or maybe the patient’s diagnosis is more complicated. Possibly, the doctor relied on heuristics – or mental shortcuts – instead of taking the time to review national guidelines recommending that all women diagnosed with breast cancer under the age of 45 consider germline genetic testing, regardless of race or ethnicity.
As we recently wrote in JCO Precision Oncology, with insights from behavioral science, the electronic health record (EHR) could be used in three ways to “nudge” doctors to overcome race as a heuristic in decision-making.