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Cited by 56Opioid Use Disorder TreatmentCultural Competency in Health CareRacial and Ethnic Identity Research

The unique and interactive effects of patient race, patient socioeconomic status, and provider attitudes on chronic pain care decisions

Open access
Anastas, Tracy M, Miller, Megan M, Hollingshead, Nicole A, Stewart, Jesse C, Rand, Kevin L, Hirsh, Adam T·2020·Annals of Behavioral Medicine
DOI 10.1093/abm/kaaa016PMC PMC7516101
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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.

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  • In Anastas et al and Wilson's studies, this led to disproportionate concerns about possible opioid addiction and triggered 'gate keeping' behaviours in the HP, affecting pain management decisions.

    “Anastas et al 72 and Wilson’s81 studies both found that people with low SES were often viewed as being untrustworthy and incapable during pain assessment, which led to disproportionate concerns about possible opioid addiction and triggered ‘gate keeping’ behaviours in the HP and this affected pain management decisions.”

    From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [72]

    The Discussion (page not provided) reports that providers were more likely to use opioid contracts with low-SES patients and suggests that beliefs about opioid misuse likely contributed. It does not establish that providers viewed these patients as incapable, specifically feared addiction, or engaged in broader ‘gate keeping’ behaviours. The paper also reports that providers were more likely to recommend opioids to low-SES patients. (LLM, conf=0.85)

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  • Anastas et al and Wilson's studies both found that people with low SES were often viewed as being untrustworthy and incapable during pain assessment.

    “Anastas et al 72 and Wilson’s81 studies both found that people with low SES were often viewed as being untrustworthy and incapable during pain assessment, which led to disproportionate concerns about possible opioid addiction and triggered ‘gate keeping’ behaviours in the HP and this affected pain management decisions.”

    From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [72]

    The Introduction says providers may worry that low-SES patients will not adhere to treatment or may misuse medication. The Discussion reports more opioid contracts for low-SES patients and suggests that beliefs about misuse contributed to this difference. It does not report that providers viewed them as incapable or untrustworthy, establish addiction concerns as the cause, or describe the contracts as ‘gate keeping’; the study also found that providers were more likely to recommend opioids to low-SES patients. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Wilson, Anastas et al and Brandao et al's studies highlight stereotyping as an influence in HP behaviour and decision-making.

    “Wilson81, Anastas et al 72 and Brandao et al’s82 studies highlight stereotyping as an influence in HP behaviour and decision-making.”

    From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [72]

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Authors
Anastas, T. M., Miller, M. M., Hollingshead, N. A., Stewart, J. C., Rand, K. L., & Hirsh, A. T.
Affiliations
  • Indiana University Indianapolis (US)
  • The Ohio State University (US)
Corresponding author
Hirsh, Adam T
ORCID
Venue
Annals of Behavioral Medicine
Publisher
Oxford University Press (OUP)
Published
2020-03-30
Volume
54
Issue
10
Pages
771-782
ISSN
  • 0742-5554 (ISSN-L)
  • 0883-6612
  • 1532-4796
DOI
10.1093/abm/kaaa016
PMC
PMC7516101
OpenAlex
W3013734246
Cited by
56
References
49
Citations by year
2026: 1 · 2025: 3 · 2024: 16 · 2023: 7 · 2022: 17 · 2021: 10 · 2020: 1
FWCI
6.56
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Annals of Behavioral Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
  • National Institute on Minority Health and Health Disparities
  • National Institutes of Health (R01MD008931)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Keywords
chronic pain management, racial disparities, socioeconomic status, provider attitudes, implicit bias, explicit attitudes, chronic back pain, opioid prescribing, workplace accommodations, pain interference, patient distress, medical residents
MeSH terms
Clinical Decision-Making, Race Factors, Adult, Attitude of Health Personnel, Female, Humans, Male, Prejudice, Social Class, Chronic Pain, Pain Management

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