Racial differences in care quality among men with newly diagnosed prostate cancer

JAMA Network Open

About The Study:

 Among men with traditional Medicare, this study examined racial differences in 2 important measures of prostate cancer care quality that have contrasting relationships with utilization. Black men had lower odds of confirmatory testing among those on active surveillance, where utilization and quality are tightly aligned, indicating worse care. Conversely, Black men had lower odds of overtreatment, where utilization and quality are misaligned, suggesting better care in this dimension. 

Corresponding Author: To contact the corresponding author, Arnav Srivastava, MD, MPH, MS, email srivasar@med.umich.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2025.23038)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

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Journal

JAMA Network Open

Improving colorectal cancer prevention and treatment for Black Americans

Researchers outline how screening, equity and policy can save more lives from colorectal cancer

University of California - Los Angeles Health Sciences

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Despite being one of the most preventable and treatable cancers, colorectal cancer continues to claim more lives in Black communities than in any other racial group in the United States. Incidence and mortality rates remain about 20% and 30% higher for Black individuals compared with White individuals, making it a leading driver of racial health disparities. 

A new review co-led by Dr. Folasade May, a gastroenterologist and cancer prevention researcher at the UCLA Health Jonsson Comprehensive Cancer Center, provides a deeper look into why these disparities persist and what can be done to eliminate them. 

Published in Nature Reviews Gastroenterology & Hepatology, the review examines the social determinants of health, such as access to health care, socioeconomic conditions and systemic inequities that prevent Black Americans from receiving timely screening, diagnosis and treatment for colorectal cancer. 

“Although overall colorectal cancer rates have declined over the past four decades, the decline has been slower among Black Americans, resulting in a persistently higher burden of disease,” said May, an associate professor of medicine at the David Geffen School of Medicine at UCLA and first author of the paper. “But for too many people, the chance to avoid a colorectal cancer diagnosis or for cure if diagnosed just doesn’t exist, not because of biological differences, but because of how social and environmental factors influence access to high-quality screening and care.” 

May and her colleagues point to a combination of modifiable risk factors and long-standing social determinants of health as key drivers of colorectal cancer disparities across the U.S. These include:  

• Lifestyle and environmental risk factors such as obesity, lack of access to healthy foods and low vitamin D levels.
• Lower screening rates due to limited access to care, financial barriers, transportation issues and mistrust of the medical system.
• Poor access to evidence-based and contemporary medical, surgical, and radiation treatments in a timely manner.
• Structural racism that affects everything from provider recommendations to the quality of care available in different neighborhoods and healthcare settings.

But these disparities are not inevitable, May noted. The paper also highlights several proven strategies that have already helped close the gap in colorectal cancer outcomes. These include:

• Culturally tailored education to raise awareness of colorectal cancer risk and screening options.
• Patient navigation programs to help individuals complete screenings and access care.
• Policies like the Affordable Care Act, which expanded access to preventive care.
• Health system changes, such as automated screening reminders and team-based care.
• Organized efforts in cities, states, and communities that include multi-component interventions to increase screening participation for Black individuals. 

“We’ve found in systems that provide equal access to all eligible users, like the Veterans Health Administration, racial disparities in screening don’t exist,” said May. “Eliminating differences in coverage policy or access to care can help address screening disparities.”

May and her team emphasize a two-pronged approach to eliminate inequities in colorectal cancer outcomes and to reduce the disease’s overall impact. The first step would be to ensure that all individuals have health insurance—regardless of background—and the ability to receive screening and guideline-based treatment. These measures have been shown to improve outcomes within just five to 10 years.

The second step involves a longer-term commitment to addressing adverse social determinants of health, such as poverty, discrimination and unequal healthcare infrastructure. By understanding how these factors influence cancer risks and treatment outcomes, researchers and policymakers can develop targeted interventions that create lasting change.

“This is a solvable problem,” May said. “We have the knowledge and resources necessary to move beyond reporting inequities to making a generational commitment to resolving the inequities in colorectal outcomes that Black people face. By taking action now, we can save lives today and create a healthier, more equitable future for all.” 

The paper’s senior author is Dr. Samir Gupta from the University of California, San Diego. Other authors are Dr. Winta Mehtsun from the University of California, San Diego and Dr. Ahmedin Jemal from the American Cancer Society. 

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Journal

Nature Reviews Gastroenterology & Hepatology

DOI

10.1038/s41575-025-01087-3 

 

Older adults with serious illness before surgery use far more health care resources after surgery

Before having elective surgery, four out of five adults aged 66 and older had a palliative care need and two out of three had serious illness

American College of Surgeons

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 Key Takeaways

• Hospital stays, readmissions, emergency department visits, and costs were almost double for older adults with serious illness before elective surgery.

• Researchers identified four palliative care needs to target before surgery: Pain, depression, functional dependence, and a need for a care partner.

• Depression was the characteristic most strongly associated with increased health care utilization and costs after surgery

CHICAGO (July 24, 2025) — Older adults who have serious illness before undergoing elective surgery had hospital stays twice as long as similarly aged counterparts; were twice as likely to return to the hospital or the emergency department; and had almost double the yearly costs of health care, according to a study published in the Journal of the American College of Surgeons.

“We were looking at the palliative care needs of this group of patients to see whether we could identify points to intervene,” said lead study author Jolene Wong Si Min, MD, of the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston and the National Cancer Center Singapore and Singapore General Hospital. “These needs were high in older adults with serious illness and who were going for major elective surgery.”

The study used data from the Health and Retirement Survey linked to Medicare claims and analyzed data from 2,499 patients aged 66 and older who had major elective surgery between 2007 and 2019.

Key Findings

• 79% of the study population had one of four clinical characteristics indicating a need for palliative care before undergoing elective surgery: moderate to severe pain; depression; functional dependence; and a need for a care partner.
• 63% of this population had serious illness.
• Seriously ill older adults with palliative care needs before surgery had higher rates of total hospital stays compared with patients who did not have serious illness before surgery.
• Adjusted one-year health care costs averaged $38,187 for this population compared with $20,129 for those without serious illness.

The study defined serious illness as any life-limiting condition that affects an individual’s quality of life or causes excessive strain on care partners. Palliative care, according to the authors, focuses on improving the quality of life through the relief of pain and psychological symptoms, addressing functional needs, and providing care partner support, among others.

“Among the four characteristics that we looked at, depression had the highest significance when it comes to having an association with health care utilization and costs,” Dr. Wong said. “If you were to choose any target to treat, it should be depression.”

Patients with serious illness and depression had significantly higher rates of health care utilization than patients without serious illness.

“An important next step would be to see how we can successfully incorporate palliative care practices in the care of seriously ill patients going for routine elective surgery,” Dr. Wong said.

While some health care advocates have held out a model of embedding palliative care specialists with surgical teams, Dr. Wong said the study authors believe training surgeons to be attentive to palliative care needs would be a more practical approach.

“Future research would be in a generalist palliative care model,” Dr. Wong said. “We feel strongly that surgeons should be trained to understand how palliative care applies to surgical practice because these needs are so common.”

Senior author of the study is Zara Cooper, MD, MSc, FACS, of the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston. Study co-authors are Yihan Wang, PhD; Evan Bollens-Lund, MA; Amanda J. Reich, PhD, MPH; Hiba Dhanani, MD; Claire K. Ankuda, MD, MPH; Stuart Lipsitz, ScD; Tamryn F. Gray, PhD, RN, MPH, ScD; Christine S. Ritchie, MD, MSPH; and Masami Tabata-Kelly, MBA, MA.

Citation: Wong Si Min J, Wang Y, Bollens-Lund E, Reich AJ, Dhanani H, Ankuda CK, Lipsitz S, Gray TF, Ritchie CS, Tabata-Kelly M, Cooper Z. Prevalence of Preoperative Palliative Care Needs and Associations with Healthcare Utilization and Costs Among Older Adults Undergoing Major Elective Surgery. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001491

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About the American College of Surgeons
The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook 

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Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001491 

Article Title

Prevalence of Preoperative Palliative Care Needs and Association with Healthcare Use and Cost Among Older Adults Undergoing Major Elective Surgery

Article Publication Date

16-Jul-2025

 

Study finds large language models (LLMs) use stigmatizing language about individuals with alcohol and substance use disorders

Mass General Brigham

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Recommended Non-Stigmatizing Language for Alcohol and Substance Use Communications 

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Credit: Mass General Brigham

As artificial intelligence is rapidly developing and becoming a growing presence in healthcare communication, a new study addresses a concern that large language models (LLMs) can reinforce harmful stereotypes by using stigmatizing language. The study from researchers at Mass General Brigham found that more than 35% of responses in answers related to alcohol- and substance use-related conditions contained stigmatizing language. But the researchers also highlight that targeted prompts can be used to substantially reduce stigmatizing language in the LLMs’ answers. Results are published in The Journal of Addiction Medicine.

“Using patient-centered language can build trust and improve patient engagement and outcomes. It tells patients we care about them and want to help,” said corresponding author Wei Zhang, MD, PhD, an assistant professor of Medicine in the Division of Gastroenterology at Mass General Hospital, a founding member of the Mass General Brigham healthcare system.  “Stigmatizing language, even through LLMs, may make patients feel judged and could cause a loss of trust in clinicians.”

LLM responses are generated from everyday language, which often includes biased or harmful language towards patients. Prompt engineering is a process of strategically crafting input instructions to guide model outputs towards non-stigmatizing language and can be used to train LLMs to employ more inclusive language for patients. This study showed that employing prompt engineering within LLMs reduced the likelihood of stigmatizing language by 88%.

For their study, the authors tested 14 LLMs on 60 generated clinically relevant prompts related to alcohol use disorder (AUD), alcohol-associated liver disease (ALD), and substance use disorder (SUD). Mass General Brigham physicians then assessed the responses for stigmatizing language using guidelines from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism (both organizations’ official names still contain outdated and stigmatizing terminology).

Their results indicated that 35.4% of responses from LLMs without prompt engineering contained stigmatizing language, in comparison to 6.3% of LLMs with prompt engineering. Additionally, results indicated that longer responses are associated with a higher likelihood of stigmatizing language in comparison to shorter responses. The effect was seen across all 14 models tested, although some models were more likely than others to use stigmatizing terms.

Future directions include developing chatbots that avoid stigmatizing language to improve patient engagement and outcomes. The authors advise clinicians to proofread LLM-generated content to avoid stigmatizing language before using it in patient interactions and to offer alternative, patient-centered language options. The authors note that future research should involve patients and family members with lived experience to refine definitions and lexicons of stigmatizing language, ensuring LLM outputs align with the needs of those most affected. This study reinforces the need to prioritize language in patient care as LLMs become increasingly used in healthcare communication.

 

Authorship: In addition to Zhang, Mass General Brigham authors include Yichen Wang, Kelly Hsu, Christopher Brokus, Yuting Huang, Nneka Ufere, Sarah Wakeman, and James Zou.

Disclosures: None.

Funding: This study was funded by grants from the May Center Clinic for Digital Health in partnership with the Mayo Clinic Office of Equity, Inclusion, and Diversity and Dalio Philanthropies.

Paper cited: Wang, Y. et. al. “Stigmatizing Language in Large Language Models for Alcohol and Substance Use

Disorders: A Multi-Model Evaluation and Prompt Engineering Approach” DOI: 10.1097/ADM.0000000000001536

 

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About Mass General Brigham

Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.

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Journal

Journal of Addiction Medicine

DOI

10.1097/ADM.0000000000001536 

Method of Research

Randomized controlled/clinical trial

Subject of Research

People

Article Title

Study Finds Large Language Models (LLMs) Use Stigmatizing Language About Individuals with Alcohol and Substance Use Disorders

Article Publication Date

24-Jul-2025

National study finds healthcare provider stigma toward substance use disorder varies sharply by condition and provider

Emergency medicine physicians show highest stigma—but also play crucial role in linking patients to treatment

Columbia University's Mailman School of Public Health

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A new national study from Columbia University Mailman School of Public Health, with colleagues at the University of Miami Miller School of Medicine, University of Chicago, National Opinion Research Center, and Emory University finds that stigma toward patients with substance use disorders (SUD) remains widespread among U.S. healthcare providers—and varies significantly across types of substances. The findings are published in the journal Addiction.

The study is the first national analysis to compare provider stigma across opioid (OUD), stimulant, and alcohol use disorders (AUD) with other chronic but often-stigmatized conditions like depression, HIV, and Type II diabetes. Researchers also assessed how stigma influences whether providers screen for SUD, offer referrals, or deliver treatment.

“While we've made progress in expanding access to evidence-based SUD treatment, stigma remains a profound barrier—often embedded in the clinical encounter itself,” said Carrigan Parish, DMD, PhD, assistant professor in the Department of Sociomedical Sciences at Columbia Mailman School of Public Health. “Our findings show that many providers still feel uncomfortable treating patients with substance use disorders and that hesitancy leads directly to missed opportunities for care. In particular, emergency departments often serve as the first—and sometimes only—point of care for people with substance use disorders. We need to leverage those moments, not miss them.”

The study, conducted from October 2020 to October 2022, surveyed 1,081 primary care providers (PCPs), 600 emergency medicine providers (EMPs), and 627 dentists using a nationally representative random sample licensed from the American Medical and Dental Associations. Participants rated their agreement with 11 standardized stigma statements and reported their screening, referral, and treatment practices for six conditions: three SUDs (opioids, stimulants, alcohol) and three comparison medical conditions (Type II diabetes, depression, HIV).

Key findings:

• Stigma score toward stimulant use disorders was highest (36.3 points, followed by OUD (35.6 points) and AUD (32 points).
• For comparison, stigma scores were far lower for depression (26.2 points, HIV (25.8 points), and Type II diabetes (23.2 points), where providers also reported higher levels of compassion and treatment.
• More than 30 percent of providers said they prefer not to work with patients with OUD or stimulant use disorders—compared to just 2 percent for diabetes, and 9 percent for both HIV and depression.
• Emergency medicine physicians (EMPs) expressed the highest levels of stigma toward SUD, yet were also the most active in providing clinical care:
  • 28.4 percent reported providing drug use treatment
  • 27.2 percent prescribed medications for opioid use disorder (MOUD) compared to just 12 percent and 10 percent of primary care physicians (PCPs) for drug use treatment and prescribing medications, respectively. 
• Dentists reported the lowest stigma levels toward all queried conditions—which may be due to greater clinical and moral distance from SUD treatment and viewing SUD-related practices as outside their scope of practice
• Stigma scores did not significantly differ by provider race, age, gender, region, or rurality, indicating that these attitudes span the healthcare workforce

“Overall, providers were less likely to feel they could effectively help patients with stimulant or opioid use disorders. In fact, 22 percent of providers said, ‘there is little I can do to help patients like this’—a response we almost never saw for other conditions,” said Daniel Feaster, PhD and professor of Biostatistics and one of the lead investigators at University of Miami.

“This isn’t just a matter of attitude—it’s about access. If a provider doubts treatment efficacy or holds stigmatizing beliefs, they’re less likely to screen or refer a patient. That becomes a system failure.”

The study also highlighted key institutional barriers that may reinforce stigma, including:

• Time constraints 
• Lack of training
• Limited referral resources
• Discomfort discussing SUD with patients
• Legal concerns
• Minimal privacy in clinical settings

Senior author Lisa R. Metsch, professor of Sociomedical Sciences at Columbia Mailman School and Dean of the School of General Studies at Columbia University added, “We heard over and over that providers feel unequipped or unsupported to treat SUD—despite being on the frontlines. That’s especially true in primary care settings, where time pressures and limited resources are a daily challenge.” Metsch also added, “Notably, the majority of health providers agreed that insurance plans should cover patients with SUD at the same degree as they cover patients with other health conditions.” 

Dentists, although typically less involved in treating SUD, are well-positioned to recognize oral signs of substance use and refer patients to appropriate care—but they, too, face gaps in training and systemic support. 

“Going forward, we should strive to be more cognizant of the many treatment and provider roles we have distinguished in this study. By unpacking all the variations, we can start to build smarter interventions—tailored by specialty, setting, and substance,” said Parish. 

Other co-authors are Viviana E. Horigian, University of Miami Miller School of Medicine; Harold A. Pollack, University of Chicago School of Social Work; Xiaoming Wang and Petra Jacobs, National Institute of Drug Abuse; Christina Drymon and Elizabeth Allen, National Opinion Research Center; Carlos del Rio, Emory University School of Medicine; and Margaret R. Pereyra and Lauren Gooden, Columbia Mailman School.

The study was supported by the National Institute on Drug Abuse Treatment Clinical Trials Network, grant 5UG1DA013720-23.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

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Journal

Addiction

DOI

10.1111/add.70122 

Article Title

Healthcare provider stigma toward patients with substance use disorders

International study reveals sex and age biases in AI models for skin disease diagnosis

Health Data Science

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Scientists from ShanghaiTech University compared the performance of large language models (LLMs), like ChatGPT-4 and LLaVA, in diagnosing skin diseases among male and female patients across different age groups. The findings point to potential biases across age and sex groups, that must be addressed before clinical deployment.

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Credit: Zhiyu Wan, Health Information Safety and Intelligence Research Lab, ShanghaiTech University (generated with the help of ChatGPT-4o)

An international research team led by Assistant Professor Zhiyu Wan from ShanghaiTech University has recently published groundbreaking findings in the journal Health Data Science, highlighting biases in multimodal large language models (LLMs) such as ChatGPT-4 and LLaVA in diagnosing skin diseases from medical images. The study systematically evaluated these AI models across different sex and age groups.

Utilizing approximately 10,000 dermatoscopic images, the study focused on three common skin diseases: melanoma, melanocytic nevi, and benign keratosis-like lesions. Results revealed that while ChatGPT-4 and LLaVA outperformed most traditional deep learning models overall, ChatGPT-4 showed greater fairness across demographic groups, whereas LLaVA exhibited significant sex-related biases.

Dr. Wan emphasized, “While large language models like ChatGPT-4 and LLaVA demonstrate clear potential in dermatology, we must address the observed biases, particularly across sex and age groups, to ensure these technologies are safe and effective for all patients.”

The team plans further research incorporating additional demographic variables like skin tone to comprehensively evaluate the fairness and reliability of AI models in clinical scenarios. This research provides critical guidance for developing more equitable and trustworthy medical AI systems.

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Journal

Health Data Science

DOI

10.34133/hds.0256 

Article Title

Evaluating Sex and Age Biases in Multimodal Large Language Models for Skin Disease Identification from Dermatoscopic Images