Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and their primary care providers.Purpose: This analysis describes rural primary care providers' perceptions of the full spectrum of breast cancer screening, treatment, and follow-up care for women patients, and it describes the providers' desired role in the cancer care continuum.Method: Focus group interviews were conducted with primary care providers in 3 federally qualified community health centers serving a lower income, rural population. Focus group participants (N = 26) consisted of 11 physicians, 14 nurse practitioners, and 1 licensed clinical psychologist. Data were generated from audiotaped interviews transcribed verbatim and investigator field notes. Data were analyzed using constant comparison and findings were reviewed with a group of rural health professionals to judge the fit of findings with the emerging coding scheme.Findings: Provider relationships were characterized as being with women with cancer and comprised an active behind-the-scenes role in supporting their patients through treatment decisions and processes. Three themes emerged from the interview data: Knowing the Patient; Walking Through Treatment With the Patient; and Sending Them Off or Losing the Patient to the System.Conclusions: These findings should be a part of professional education for rural practitioners, and mechanisms to support this role should be implemented in practice settings.

Breast cancer remains a significant public health concern worldwide, with persisting disparities in several aspects of breast cancer care. Implicit bias has emerged as a potential contributor to these disparities. While previous research has examined implicit bias in healthcare, particularly in the context of racial and ethnic disparities, no review has been conducted to examine the association of physician implicit bias and breast cancer care. There remains a need for further investigation into its role in breast cancer care. This scoping review aims to systematically analyze the existing literature on physician implicit bias in breast cancer care to discern its potential influence on healthcare disparities. Through this analysis, we aim to identify key gaps and patterns in the literature, as well as to gain a comprehensive understanding of the role of physician implicit bias in breast cancer care. Our findings are intended to inform future research directions and contribute to the ongoing discussion on healthcare disparities and outcomes. The scoping review employed a systematic search strategy across three databases: APA PsycINFO, PubMed, and Web of Science. The search focused on articles examining implicit bias in breast cancer screening, diagnosis, and treatment/outcome disparities. Inclusion criteria encompassed studies published between 2013 and 2023, with data extracted and summarized using EndNote. Screening and methodological quality assessment were conducted by two undergraduate students, with discrepancies resolved through discussion and consultation with the thesis chair. Six articles were included in the scoping review, primarily focusing on treatment-related disparities. Self-administered methods, including the Implicit Association Test, were commonly used to assess implicit bias among healthcare providers. The studies highlighted demographic disparities among physicians and identified variables such as physician characteristics, patient experiences, and race/ethnicity as factors influencing implicit bias in breast cancer care. The scoping review identified a limited number of studies addressing implicit bias in breast cancer care, indicating a need for further investigation, particularly in the areas of screening and diagnosis disparities. The findings underscore the importance of considering both provider and patient perspectives in understanding and addressing healthcare disparities. Future research should explore demographic factors such as physician age and gender and continue to examine variables influencing implicit bias to inform interventions aimed at promoting equitable care for all breast cancer patients. It is important to acknowledge that although factors like mistrust may shape behaviors that could affect healthcare disparities, the few studies identified in this scoping review did not test whether a correlation exists between these factors and predictors of healthcare disparities. This highlights the necessity for further research to explore potential associations between physician implicit bias and healthcare disparities.