University of North Texas Health Science Center, Fort Worth.
JAMA Netw Open. 2022 Jun 1;5(6):e2216270. doi: 10.1001/jamanetworkopen.2022.16270.
Racial and ethnic disparities in pain outcomes are widely reported in the United States. However, the impact of the patient-physician relationship on such outcomes remains unclear.
To determine whether the patient-physician relationship mediates the association of race with pain outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study uses data from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation, collected from April 2016 to December 2021. All registry enrollees who identified as Black or White with chronic low back pain who had a regular physician who provided pain care were included. Data were analyzed during December 2021.
Participant-reported aspects of their patient-physician relationship, including physician communication, physician empathy, and satisfaction with physician encounters.
The primary outcomes included low back pain intensity, measured with a numerical rating scale and physical function, measured with the Roland-Morris Disability Questionnaire. Mediator variables were derived from the Communication Behavior Questionnaire, Consultation and Relational Empathy measure, and Patient Satisfaction Questionnaire.
Among 1177 participants, the mean (SD) age was 53.5 (13.1) years, and there were 876 (74.4%) women. A total of 217 participants (18.4%) were Black, and 960 participants (81.6%) were White. The only difference between Black and White participants in the patient-physician relationship involved effective and open physician communication, which favored Black participants (mean communication score, 72.1 [95% CI, 68.8-75.4] vs 67.9 [95% CI, 66.2-69.6]; P = .03). Black participants, compared with White participants reported worse outcomes for pain intensity (mean pain score, 7.1 [95% CI, 6.8-7.3] vs 5.8 [95% CI, 5.7-6.0]; P < .001) and back-related disability (mean disability score, 15.8 [95% CI, 15.1-16.6] vs 14.1 [95% CI, 13.8-14.5]; P < .001). In mediation analyses that controlled for potential confounders using disease risk scores, virtually none of the associations of race with each outcome was mediated by the individual or combined factors of physician communication, physician empathy, and patient satisfaction. Similarly, no mediation was observed in sensitivity analyses that included only participants with both chronic low back pain and the same treating physician for more than 5 years.
These findings suggest that factors other than the patient-physician relationship were important to pain disparities experienced by Black participants. Additional research on systemic factors, such as access to high-quality medical care, may be helpful in identifying more promising approaches to mitigating racial pain disparities.
在美国，种族和民族差异在疼痛结果中广泛报道。然而，医患关系对这些结果的影响仍不清楚。
确定医患关系是否调解种族与疼痛结果之间的关联。
设计、地点和参与者：本横断面研究使用了 2016 年 4 月至 2021 年 12 月从疼痛登记处为流行病学、临床和干预研究和创新收集的数据。所有登记在册的慢性腰痛且有常规医生提供疼痛护理的黑人或白人患者均被纳入。数据分析于 2021 年 12 月进行。
参与者报告了他们与医生的关系的各个方面，包括医生的沟通、医生的同理心和对医生就诊的满意度。
主要结果包括使用数字评分量表测量的腰痛强度和使用 Roland-Morris 残疾问卷测量的身体功能。中介变量来自沟通行为问卷、咨询和关系同理心量表以及患者满意度问卷。
在 1177 名参与者中，平均（SD）年龄为 53.5（13.1）岁，其中 876 名（74.4%）为女性。共有 217 名参与者（18.4%）为黑人，960 名参与者（81.6%）为白人。黑人参与者和白人参与者在医患关系方面唯一的区别是有效的和开放的医生沟通，这有利于黑人参与者（平均沟通评分，72.1 [95%CI，68.8-75.4] 与 67.9 [95%CI，66.2-69.6]；P=0.03）。与白人参与者相比，黑人参与者报告的疼痛强度（平均疼痛评分，7.1 [95%CI，6.8-7.3] 与 5.8 [95%CI，5.7-6.0]；P<0.001）和背部相关残疾（平均残疾评分，15.8 [95%CI，15.1-16.6] 与 14.1 [95%CI，13.8-14.5]；P<0.001）的结果更差。在使用疾病风险评分控制潜在混杂因素的中介分析中，种族与每个结果的关联几乎都没有被医生沟通、医生同理心和患者满意度的单个或综合因素调解。同样，在仅包括慢性腰痛和相同治疗医生治疗时间超过 5 年的参与者的敏感性分析中，也没有观察到中介作用。
这些发现表明，除了医患关系之外，其他因素对黑人参与者的疼痛差异很重要。关于系统因素（如获得高质量医疗保健）的进一步研究可能有助于确定缓解种族疼痛差异更有希望的方法。
