Bias in pain care: What patient variables do providers report as influencing their treatment decisions?

dc.contributor.advisorHirsh, Adam
dc.contributor.authorRose-McCandlish, Margaret
dc.contributor.otherMosher, Catherine
dc.contributor.otherStewart, Jesse
dc.date.accessioned2024-11-06T08:29:03Z
dc.date.available2024-11-06T08:29:03Z
dc.date.issued2024-10
dc.degree.date2024
dc.degree.disciplineDepartment of Psychologyen
dc.degree.grantorIndiana University
dc.degree.levelM.S.
dc.descriptionIUI
dc.description.abstractRacialized and low socioeconomic status (SES) patients are often under-treated for chronic pain, despite reporting more pain on average. This disparity is likely due to multiple systemic factors, including healthcare provider bias. Providers often treat patients differently for chronic pain depending on the patient’s race and SES, but little is known about providers’ awareness of the extent to which patient demographic variables influence their pain treatment decisions. The present study examined the variables that providers report as influencing their pain treatment decisions, whether these variables group together to form distinct factors, and whether providers who demonstrate racial or socioeconomic bias in their treatment decisions report different patient variables or factors as influencing their treatment decisions compared to providers who did not demonstrate biases. Four hundred thirty-two United States-based physician residents and fellows (“providers”) made treatment decisions for 12 computer-simulated patients with chronic pain who varied by race (Black/White) and SES (high/low). Providers then rated the level to which 15 different variables influenced their treatment decision-making. Robust repeated measures ANOVAs indicated that providers rated patient sex/gender, age, and race as the least influential variables in their pain treatment decisions for the simulated patients. For the factor analysis, I sequentially omitted variables to achieve proper model fit and reliability and arrived at a three-factor solution; I labelled these factors Demographic, Biomedical, and Psychosocial, according to the variables’ conceptual overlap. Robust repeated measures ANOVAs found that reported use of variables did not differ between the providers who demonstrated bias and those who did not demonstrate bias, nor did factor scores for the three factors. The present study suggests that providers have low awareness of the extent to which patient race and SES may influence their clinical decision-making in pain care. Results can help inform future research to improve interventions to reduce the impact of racial and socioeconomic bias on providers’ treatment decisions for patients with chronic pain.
dc.identifier.urihttps://hdl.handle.net/1805/44419
dc.language.isoen
dc.subjectChronic pain
dc.subjectHealth disparities
dc.subjectClinical decision-making
dc.subjectRacial bias
dc.subjectSocioeconomic bias
dc.subjectPain treatment
dc.titleBias in pain care: What patient variables do providers report as influencing their treatment decisions?
dc.typeThesisen
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