The Interaction of Patient Race, Provider Bias, and Clinical Ambiguity on Pain Management Decisions

JOURNAL OF PAIN

卷:16

Article

Hirsh, Adam T.¹  Hollingshead, Nicole A.¹  Ashburn-Nardo, Leslie¹  Kroenke, Kurt^2,3,4 

[1] Indiana Univ Purdue Univ, Dept Psychol, Indianapolis, IN 46202 USA

[2] Roudebush VA Med Ctr, Ctr Excellence Implementing Evidence Based Practi, VA Hlth Serv Res & Dev, Indianapolis, IN USA

[3] Indiana Regenstrief Inst Inc, Indianapolis, IN USA

[4] Indiana Univ Sch Med, Dept Med, Indianapolis, IN 46202 USA

关键词: Race;    bias;    disparities;    decision making;   

DOI  :  10.1016/j.jpain.2015.03.003

来源: Elsevier

【 摘 要 】

Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty-nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and nonopioid analgesics) decisions for 12 virtual patients with acute pain. Race (black/white) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers' decisions, such that decisions varied as a function of ambiguity for white but not for black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however, providers' implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between white and black patients are, in part, attributable to the nature (ie, ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors. Perspective: This study examined the unique and collective influence of patient race, provider racial bias, and clinical ambiguity on providers' pain management decisions. These results could inform the development of interventions aimed at reducing disparities and improving pain care. (C) 2015 by the American Pain Society

【 授权许可】

Free