Iscte-Instituto Universitário de Lisboa, Centro de Investigação e Intervenção Social, Lisbon, Portugal.
CIP-Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisbon, Portugal.
Pain. 2021 Dec 1;162(12):2854-2864. doi: 10.1097/j.pain.0000000000002278.
Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.
与种族主义和性别歧视相比，在疼痛评估和管理实践（PAMPs）中，阶级主义的研究较少，其介导机制尚不清楚。本研究借鉴去人性化的社会心理模型，旨在测试：（1）患者社会经济地位（SES；社会阶级的代表）对 PAMPs 的影响，以及（2）患者去人性化和感知生活困难是否在这些影响中起中介作用。进行了两项在线实验研究，其中在个体内操纵了患者 SES（低与高）。162 名女性医学生（研究 1）和 105 名女性护士（研究 2）接受了 2 个慢性下背痛女性病例的情景描述/图像，然后观看了她们进行疼痛诱发运动的视频。参与者报告了患者去人性化、感知生活困难和 PAMPs。低 SES 患者被认为对疼痛的敏感性较低（仅医学生），但残疾程度更高、更可信，而且其疼痛更多归因于心理原因（仅护士）。医学生建议较少的非药物治疗，但开出的药物略强。医学生不太愿意为低 SES 患者提供个性化护理，而护士则表现出相反的模式。患者机械去人性化中介了 SES 对疼痛残疾的影响（仅医学生）。感知生活困难中介了 SES 对疼痛残疾、可信度（仅护士）和提供个性化护理意愿的影响（仅护士）。这些发现为疼痛、卫生服务研究和社会心理学领域做出了新的贡献，并对制定更有效的未来干预措施以减少 PAMPs 中的阶级主义具有重要意义。
