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The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions.

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Title: The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions.
Authors: Anastas, Tracy M (AUTHOR), Miller, Megan M (AUTHOR), Hollingshead, Nicole A (AUTHOR), Stewart, Jesse C (AUTHOR), Rand, Kevin L (AUTHOR), Hirsh, Adam T (AUTHOR)
Source: Annals of Behavioral Medicine. Oct2020, Vol. 54 Issue 10, p771-782. 12p.
Subjects: Chronic pain, Attitude (Psychology), Implicit attitudes, Pain clinics, Backache, Racial differences, Black people
Abstract: Background: Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES.Purpose: We examined the effects of patient race and SES on providers' chronic pain decisions and the extent to which providers' implicit and explicit attitudes about race and SES were related to these decisions.Methods: Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES.Results: There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers' implicit and explicit attitudes predicted some, but not all, of their pain-related ratings.Conclusion: These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care. [ABSTRACT FROM AUTHOR]
Copyright of Annals of Behavioral Medicine is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
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  Data: The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions.
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  Data: <searchLink fieldCode="AR" term="%22Anastas%2C+Tracy+M%22">Anastas, Tracy M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Miller%2C+Megan+M%22">Miller, Megan M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hollingshead%2C+Nicole+A%22">Hollingshead, Nicole A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stewart%2C+Jesse+C%22">Stewart, Jesse C</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rand%2C+Kevin+L%22">Rand, Kevin L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hirsh%2C+Adam+T%22">Hirsh, Adam T</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Annals+of+Behavioral+Medicine%22">Annals of Behavioral Medicine</searchLink>. Oct2020, Vol. 54 Issue 10, p771-782. 12p.
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  Data: <searchLink fieldCode="DE" term="%22Chronic+pain%22">Chronic pain</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+%28Psychology%29%22">Attitude (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Implicit+attitudes%22">Implicit attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Pain+clinics%22">Pain clinics</searchLink><br /><searchLink fieldCode="DE" term="%22Backache%22">Backache</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+differences%22">Racial differences</searchLink><br /><searchLink fieldCode="DE" term="%22Black+people%22">Black people</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: <bold>Background: </bold>Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES.<bold>Purpose: </bold>We examined the effects of patient race and SES on providers' chronic pain decisions and the extent to which providers' implicit and explicit attitudes about race and SES were related to these decisions.<bold>Methods: </bold>Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES.<bold>Results: </bold>There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers' implicit and explicit attitudes predicted some, but not all, of their pain-related ratings.<bold>Conclusion: </bold>These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Annals of Behavioral Medicine is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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        Value: 10.1093/abm/kaaa016
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        Text: English
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        PageCount: 12
        StartPage: 771
    Subjects:
      – SubjectFull: Chronic pain
        Type: general
      – SubjectFull: Attitude (Psychology)
        Type: general
      – SubjectFull: Implicit attitudes
        Type: general
      – SubjectFull: Pain clinics
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      – SubjectFull: Backache
        Type: general
      – SubjectFull: Racial differences
        Type: general
      – SubjectFull: Black people
        Type: general
    Titles:
      – TitleFull: The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions.
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              Text: Oct2020
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              Y: 2020
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