ABSTRACT Bias is present in multiple facets of life and influences decision-making particularly among racial/ethnicminorities. Bias also likely plays a strong role in the process of selecting candidates for advanced heart failuretherapies including heart transplants and left ventricular assist devices because of the subjective nature of theprocess. Implicit bias has been well studied in medicine but has not been found to be universally instrumentalin changing outcomes and healthcare group decision-making has not been well studied. Therefore theapplication of mixed-methods to study individual healthcare provider bias and group decision-making isinnovative. For the first time the think aloud protocol a method of elucidating decision-making thoughts forthematic qualitative analysis and a visual analog scale survey will be used to assess individual provider biasand the de Groot Critically Reflective Diagnosis protocol a methodical quantification of reflective groupdecision-making will be used to assess the group decision-making process for selection of candidates foradvanced therapy for heart failure. We will identify the single most important subjective factor that contributesto racial/ethnic bias and lower reflective scores. An objective measurement of this factor will be used in astandardized protocol for evaluating patients for advanced therapies. Naturalistic evaluation of implementationof this protocol will lead to protocol tailoring that will provide groundwork for a pragmatic R01 trial. The findingsof this study will also have implications for other populations that use multidisciplinary healthcare providers fordecision-making such as selection of patients for transcatheter aortic valve replacement and transplantation ofother organs.