Browsing by Author "Hollingshead, Nicole A."
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Item Associations between immigrant status and pharmacological treatments for diabetes in U.S. adults(APA, 2018) Hsueh, Loretta; Vrany, Elizabeth A.; Patel, Jay S.; Hollingshead, Nicole A.; Hirsh, Adam T.; de Groot, Mary; Stewart, Jesse C.; Psychology, School of ScienceObjectives: Although treatment disparities in diabetes have been documented along racial/ethnic lines, it is unclear if immigrant groups in the United States experience similar treatment disparities. Our objective was to determine whether immigrant status is associated with differences in pharmacological treatment of diabetes in a nationally representative sample of adults with diabetes. We were specifically interested in differences in treatment with oral hypoglycemic agents (OHA) and insulin. Method: Respondents were 2,260 adults from National Health and Nutritional Examination Survey (NHANES) 2003–2012 with a self-reported diabetes diagnosis. Immigrant status was indicated by birth within (U.S.-born) or outside (foreign-born) the 50 U.S. States or Washington, DC. Multinomial logistic regression analyses examined associations between immigrant status and (a) treatment with OHAs only and (b) treatment with insulin only or insulin and OHA combination therapy, using no treatment as the reference group. Results: Adjusting for demographics, diabetes severity and duration, cardiovascular disease (CVD), and CVD risk factors, being foreign-born versus U.S.-born was not associated with treatment with OHAs only (odds ratio [OR] = 1.59; 95% confidence interval [CI] [0.97, 2.60]). However, being foreign-born was associated with decreased odds (OR = 0.53; 95% CI [0.28, 0.99]) of treatment with insulin. Conclusions: Pharmacological treatment of diabetes differs along immigrant status lines. To understand these findings, studies capturing the processes underlying treatment differences in diabetes among immigrants are needed. Findings raise the possibility that integrating information about a patient’s immigrant status, in addition to racial/ethnic identity, may be an important component of culturally sensitive diabetes care.Item A comparison of race-related pain stereotypes held by White and Black individuals(Wiley, 2016-12) Hollingshead, Nicole A.; Meints, Samantha M.; Miller, Megan M.; Robinson, Michael E.; Hirsh, Adam T.; Psychology, School of SciencePain judgments are the basis for pain management. The purpose of this study was to assess Black and White participants’ race-related pain stereotypes. Undergraduates (n=551) rated the pain sensitivity and willingness to report pain for the typical Black person, White person, and themselves. Participants, regardless of race, rated the typical White person as being more pain sensitive and more willing to report pain than the typical Black person. White participants rated themselves as less sensitive and less willing to report pain than same-race peers; however, Black participants rated themselves as more pain sensitive and more willing to report pain than same-race peers. These findings highlight similarities and differences in racial stereotypic pain beliefs held by Black and White individuals.Item Differences in Mexican Americans’ Prevalence of Chronic Pain and Co-Occurring Analgesic Medication and Substance Use Relative to Non-Hispanic White and Black Americans: Results from NHANES 1999–2004(Oxford, 2016-06) Hollingshead, Nicole A.; Vrany, Elizabeth A.; Stewart, Jesse C.; Hirsh, Adam T.; Department of Psychology, School of ScienceObjective. Little is known about the burgeoning Mexican American (MA) population’s pain experience. Methods. Using 1999–2004 National Health and Nutrition Examination Survey (NHANES) data, prevalence of chronic pain, analgesic medication use, and substance use were examined among MA, non-Hispanic White (NHW), and non-Hispanic Black (NHB) respondents. Logistic and linear regression models examined racial/ethnic differences in: 1) chronic pain prevalence among all respondents, 2) location and number of pain sites among respondents with chronic pain, and 3) analgesic medication and substance use among respondents with chronic pain. Results. Compared to NHWs and NHBs, MAs were less likely to report any chronic pain. Among respondents with chronic pain, MAs had higher odds of reporting headache, abdominal pain, and a greater number of pain sites than NHWs. Compared to NHWs, MAs with chronic pain had lower odds of reporting past-month analgesic medication and COX-2 inhibitor use. MAs with chronic pain had lower odds of being a current cigarette smoker and heavy alcohol drinker but had similar street drug/cocaine use relative to NHWs. Conclusions. Results suggest that: 1) MAs are less likely to develop chronic pain than NHWs, 2) MAs with chronic pain report greater headache and abdominal pain than NHWs, and 3) MAs with chronic pain are less likely to use analgesic medications and other substances compared to NHWs. These results suggest that providers should consider taking extra time to discuss analgesic medications with MAs. Future investigations should examine reasons underlying these racial/ethnic differences in chronic pain, as well as differences in the use of other substances, such as marijuana.Item Examining influential factors in providers' chronic pain treatment decisions: a comparison of physicians and medical students(BioMed Central, 2015-10-01) Hollingshead, Nicole A.; Meints, Samantha; Middleton, Stephanie K.; Free, Charnelle A.; Hirsch, Adam T.; Department of Psychology, School of ScienceBACKGROUND: Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers' chronic pain treatment decisions. A secondary aim was to examine differences across participant training level. METHODS: Eighty-five participants (35 medical students, 50 physicians) made treatment decisions for 16 computer-simulated patients with chronic pain. Participants then selected from provided lists the information they used and the information they would have used (had it been available) to make their chronic pain treatment decisions for the patient vignettes. RESULTS: Frequency analyses indicated that most participants reported using patients' pain histories (97.6 %) and pain description (95.3 %) when making treatment decisions, and they would have used information about patients' previous treatments (97.6 %) and average and current pain ratings (96.5 %) had this information been available. Compared to physicians, medical students endorsed more frequently that they would have used patients' employment and/or disability status (p < 0.05). A greater proportion of medical students wanted information on patients' use of illicit drugs and alcohol to make treatment decisions; while a greater proportion of physicians reported using personal experience to inform their decisions. DISCUSSION: This study found providers use patients' information and their own experiences and intuition to make chronic pain treatment decisions. Also, participants of different training levels report using different patient and personal factors to guide their treatment decisions. CONCLUSIONS: These results highlight the complexity of chronic pain care and suggest a need for more chronic pain education aimed at medical students and practicing providers.Item Examining influential factors in providers’ chronic pain treatment decisions: a comparison of physicians and medical students(BMC, 2015) Hollingshead, Nicole A.; Meints, Samantha; Middleton, Stephanie K.; Free, Charnelle A.; Hirsh, Adam T.; Department of Psychology, School of ScienceChronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers’ chronic pain treatment decisions. A secondary aim was to examine differences across participant training level.Item Examining Influential Factors in Providers’ Chronic Pain Treatment Decisions: A Comparison of Physicians and Medical Students(Office of the Vice Chancellor for Research, 2014-04-11) Free, Charnelle A.; Hollingshead, Nicole A.; Meints, Samantha M.; Middleton, Stephanie; Hirsh, Adam T.Reports have found that chronic pain management guidelines are unclear and conflicting. Due to this confusion, it is critical to understand factors that influence providers’ treatment decisions for chronic pain. Little is known about which factors providers use to make treatment decisions or whether providers of different training levels endorse using similar factors. The purpose of this study was to examine the factors that providers report using to make their chronic pain treatment decisions. We hypothesized that providers would: (1) prioritize objective factors over subjective factors, (2) be particularly interested in information about patients’ substance use, and (3) endorse using different factors depending on their training level (physicians vs. medical students). Eighty-five providers (35 medical students, 50 physicians) viewed 16 computer-simulated patients; each included a picture with text describing the patients’ condition (i.e., chronic lower back pain, open to any treatment, presence/absence of depression). After making treatment decisions, participants selected from a list the factors they used and would have used (if the information had been available) to make their treatment decisions. Most providers reported being influenced by patients’ pain histories (97.6%) and pain descriptions (95.3%). Providers indicated they would have used information about patients’ previous treatments (97.6%), average pain ratings (96.5%), and current pain (96.5%) had this information been available. Compared to physicians, medical students endorsed more often that they would have used patients’ employment and/or disability status (p<.01), illicit drug use (p=.09), and alcohol use (p=.08) to make treatment decisions. These results indicate that providers rely on objective and subjective information to make pain treatment decisions, and compared to physicians, medical students place a stronger emphasis on patients’ substance abuse and social history when making treatment decisions. Future studies should examine additional provider and patient factors that influence decisions for specific pain treatment options.Item Examining the influence of Hispanic ethnicity and ethnic bias on medical students’ pain decisions(2016-05-09) Hollingshead, Nicole A.; Hirsh, Adam Todd; Ashburn-Nardo, Leslie; Stewart, Jesse; Maupomé, Gerardo; Grahame, Nicholas J.Hispanic patients receive disparate pain care compared to non-Hispanic White (NHW) patients. Healthcare providers’ ethnic bias may be one reason for pain disparities. This investigation sought to determine the influence of Hispanic ethnicity and ethnic bias on chronic pain management decisions. During an online experiment, 97 medical students made pain assessment and opioid treatment decisions for Hispanic and NHW virtual human patients with chronic pain. They also completed explicit and implicit measures of ethnic bias. Individual-level analyses found that 31% and 36% of participants demonstrated large effect sizes (dz>.50), indicating that patient ethnicity strongly influenced their pain assessment and opioid treatment decisions, respectively. At the group level of analysis, participants’ decisions did not differ significantly between NHW and Hispanic patients (all p values >.05). Participants did not report significant explicit ethnic bias (t[96]=1.88, p=.06; dz=.19; Hispanic mean rating=77.6[SD=18.7]; NHW mean rating=75.2[SD=19.4]) but demonstrated a small-to-moderate implicit preference for NHWs relative to Hispanics (Mean=.31[SD=.41]). Patient ethnicity and implicit ethnic bias had an interactive effect on opioid treatment decisions (F[1, 95]=5.15, p<.05, generalized eta squared =.02); however, the direction of the effect was not as hypothesized. Participants with higher implicit ethnic bias gave significantly higher opioid ratings to Hispanics relative to NHWs (p=.05), whereas participants with lower bias gave marginally higher opioid ratings to NHWs relative to Hispanics (p=.20). Participants with higher vs. lower implicit ethnic bias differed only in their treatment ratings for NHW patients, such that participants with lower bias gave significantly higher opioid ratings to NHW patients than did participants with higher bias (p<.05). This investigation found that approximately one-third of participants made significantly different chronic pain management decisions for Hispanic vs. NHW patients. Participants’ implicit ethnic bias interacted with their opioid treatment decisions but not as expected. Future investigations should measure healthcare providers’ stereotypes about Hispanic patients with pain as this may better predict their pain decisions.Item Factors that Influence Providers’ Pain Treatment Decisions(Office of the Vice Chancellor for Research, 2013-04-05) Free, Charnelle A.; Hollingshead, Nicole A.; Hirsh, Adam T.Medical and non-medical factors influence providers’ pain treatment decisions. Among these, patient demographic characteristics and substance use have received particular attention. However, few empirical studies have examined the specific factors providers rely on for their pain treatment decisions. This study employed lens model methodology to examine the factors that providers reportedly used, actually used, and would have used (if available) to make pain treatment decisions. We hypothesized that: (1) providers would rate patients’ pain history and description of pain as the most influential factors provided in the clinical vignettes, and (2) providers would rate patients’ substance use history as the most important factor not provided in the vignettes. 100 providers viewed 16 computer-simulated patients; each included a picture with accompanying text describing the patient’s medical condition. After making multi-modal treatment ratings for each patient, providers indicated the factors they used to make treatment decisions and the factors they would have used (if available) to make decisions. Results indicated that most providers reported being influenced by patients’ pain histories (98%) and descriptions (96%), whereas fewer reported using patients' movement (75%) or demographic characteristics (62%). Providers reported that they wanted additional information on patients’ treatment histories (98%), current/average pain (96%), and drug use (94%) to guide their decisions. Exploratory analyses indicated that, compared to providers who were not statistically influenced by patient demographics, a slightly greater proportion of providers who were statistically influenced by patient demographics wanted additional information about patients’ alcohol use to inform their decisions, χ2 (1) = 3.09, p = .08. These results suggest that providers prioritize both objective and subjective information about patients’ pain conditions, as well as patients’ substance use behaviors, when making treatment decisions. These findings have important implications for pain management and may lead to improved patient safety and care.Item Impact of Race and Sex on Pain Management by Medical Trainees: A Mixed Methods Pilot Study of Decision Making and Awareness of Influence(Wiley, 2015-02) Hollingshead, Nicole A.; Matthias, Marianne S.; Bair, Matthew J.; Hirsh, Adam T.; Department of Psychology, IU School of ScienceObjective Previous research suggests female and black patients receive less optimal treatment for their chronic pain compared with male and white patients. Provider-related factors are hypothesized to contribute to unequal treatment, but these factors have not been examined extensively. This mixed methods investigation examined the influence of patients' demographic characteristics on providers' treatment decisions and providers' awareness of these influences on their treatment decisions. Methods Twenty medical trainees made treatment decisions (opioid, antidepressant, physical therapy) for 16 virtual patients with chronic low back pain; patient sex and race were manipulated across patients. Participants then indicated from a provided list the factors that influenced their treatment decisions, including patient demographics. Finally, individual interviews were conducted to discuss the role of patient demographics on providers' clinical decisions. Results Individual regression analyses indicated that 30% of participants were reliably influenced by patient sex and 15% by patient race when making their decisions (P < 0.05 or P < 0.10). Group analyses indicated that white patients received higher antidepressant recommendations, on average, than black patients (P < 0.05). Half of the medical trainees demonstrated awareness of the influence of demographic characteristics on their decision making. Participants, regardless of whether they were influenced by patients' demographics, discussed themes related to patient sex and race; however, participants' discussion of patient demographics in the interviews did not always align with their online study results. Conclusions These findings suggest there is a considerable variability in the extent to which medical trainees are influenced by patient demographics and their awareness of these decision making influences.Item The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions(Elsevier, 2015-06) Hirsh, Adam T.; Hollingshead, Nicole A.; Ashburn-Nardo, Leslie; Kroenke, Kurt; Department of Psychology, School of ScienceAlthough 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.