Elsevier

The Journal of Pain

Volume 16, Issue 6, June 2015, Pages 558-568
The Journal of Pain

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

https://doi.org/10.1016/j.jpain.2015.03.003Get rights and content
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Highlights

  • We examined how patient race, provider bias, and clinical ambiguity influence pain care.

  • Providers' decisions varied as a function of ambiguity for white but not for black patients.

  • Provider racial bias was not associated with differences in treatment decisions.

Abstract

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.

Key words

Race
bias
disparities
decision making

Cited by (0)

The authors report no conflicts of interest. This work was supported by grants from the National Institutes of Health (R01MD008931) and the American Pain Society (Future Leaders in Pain Research) awarded to A.H. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.