Hirsh Adam T, Hollingshead Nicole A, Ashburn-Nardo Leslie, Kroenke Kurt
Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
J Pain. 2015 Jun;16(6):558-68. doi: 10.1016/j.jpain.2015.03.003. Epub 2015 Mar 28.
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.
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.
尽管疼痛护理方面的种族差异已有广泛报道，但关于医疗服务提供者和环境因素的作用仍有许多有待了解之处。我们使用计算机模拟患者来研究患者种族、医疗服务提供者的种族偏见以及临床不确定性对疼痛决策的影响。129名住院医师/研究员为12名患有急性疼痛的虚拟患者做出评估（疼痛强度）和治疗（阿片类和非阿片类镇痛药）决策。在不同的病例描述中对种族（黑人/白人）和临床不确定性（高/低）进行了操控。参与者完成了内隐联想测验和感觉温度计，分别用于评估内隐和外显的种族偏见。个体层面和小组层面的分析表明，种族和不确定性对医疗服务提供者的决策有交互作用，即决策因白人患者的不确定性而变化，但黑人患者并非如此。观察到医疗服务提供者之间在种族和不确定性对决策的影响方面存在个体差异；然而，医疗服务提供者的内隐和外显偏见并不能解释这种变异性。这些数据凸显了种族差异的复杂性，并表明白人和黑人患者在护理上的差异部分归因于临床情况的性质（即不确定性）。当前研究表明，减少差异的干预措施应分别针对患者、医疗服务提供者和环境因素。
本研究考察了患者种族、医疗服务提供者的种族偏见以及临床不确定性对医疗服务提供者疼痛管理决策的独特和共同影响。这些结果可为旨在减少差异和改善疼痛护理的干预措施的制定提供参考。
