The Interaction of Patient Race, Provider Bias, and Clinical Ambiguity on Pain Management Decisions
Open accessAbstract
Unlabelled Although 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.
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Several studies published after 2013 indicated a null relationship between levels of implicit bias and clinical decision-making.
“Several studies post 2013 (thus after our cut-off date) have also indicated a null relationship between levels of implicit bias and clinical decision-making [52–54].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [54]
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- Authors
- Hirsh, A. T., Hollingshead, N. A., Ashburn-Nardo, L., & Kroenke, K.
- Affiliations
- Indiana University – Purdue University Indianapolis (US)
- Regenstrief Institute (US)
- Corresponding author
- Hirsh, Adam T.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 16
- Issue
- 6
- Pages
- 558-568
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC4456233
- OpenAlex
- W2093661016
- Cited by
- 162
- References
- 64
- Citations by year
- 2026: 6 · 2025: 19 · 2024: 13 · 2023: 15 · 2022: 19 · 2021: 23 · 2020: 18 · 2019: 20 · 2018: 12 · 2017: 5 · 2016: 10 · 2015: 2
- FWCI
- 32.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- PMC
- Funders
- American Pain Society
- National Institutes of Health
- National Institute on Minority Health and Health Disparities (R01MD008931)
- Topics
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- patient race, implicit racial bias, opioid prescribing, acute pain, medical residents and fellows
- MeSH terms
- Aged, Aged, 80 and over, Analgesics, Opioid, Attitude of Health Personnel, Black or African American, Decision Making, Female, Humans, Male, Middle Aged, Pain, Surveys and Questionnaires, White People, Healthcare Disparities, Pain Management, Racism
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