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Cited by 17Musculoskeletal pain and rehabilitationPain Management and Opioid UsePediatric Pain Management Techniques

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

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Brandão, Tânia, Campos, Lúcia, de Ruddere, Lies, Goubert, Liesbet, Bernardes, Sónia F·2019·Pain Medicine
DOI 10.1093/pm/pnz148
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Abstract

Objective: Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses’ pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices. Design: Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design. Subjects: Female nurses participated in two experimental studies (N = 150/N = 158). Methods: Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices. Results: The low-SES patient’s pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient’s pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices. Conclusions: Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

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  • Brandao et al reported that people with low SES were viewed as less credible during pain assessment by an HP.

    “Brandao et al 82 reported that people with low SES were viewed as less credible during pain assessment by an HP.”

    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 [82]

    The Discussion reports that nurses judged the low-SES woman's pain as slightly less credible, but only when distress cues were present. The claim omits that condition and generalizes the finding from a woman assessed by nurses to people with low SES assessed by a health professional. (LLM, conf=0.88)

    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 [82]

    The Introduction describes classism as operating through stereotyping, and the limitations section reports experimental evidence that patient socioeconomic status affected nurses’ pain assessments. But the paper says it did not test the mechanisms behind those biases, and the Discussion says its hypotheses about pain-management intentions were not confirmed. It therefore does not establish that stereotyping itself influenced the nurses’ decisions. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Brandão, T., Campos, L., de Ruddere, L., Goubert, L., & Bernardes, S. F.
Affiliations
  • Autonomous University of Lisbon (PT)
  • Iscte – Instituto Universitário de Lisboa (PT)
  • Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
  • Ghent University (BE)
Corresponding author
Bernardes, Sónia F
ORCID
Venue
Pain Medicine
Publisher
Oxford University Press (OUP)
Published
2019-07-30
Volume
20
Issue
11
Pages
2094-2105
ISSN
  • 1526-2375 (ISSN-L)
  • 1526-4637
DOI
10.1093/pm/pnz148
OpenAlex
W2966823165
Cited by
17
References
7
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 1
FWCI
1.08
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Pain Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
  • Repositório Institucional da Universidade Autónoma de Lisboa (Universidade Autónoma de Lisboa) (submittedVersion, cc-by-nc-nd)
  • Repositório do ISCTE-IUL (submittedVersion, cc-by-nc-nd)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
Funders
Fundação para a Ciência e Tecnologia (PTDC/MHC-PSC/2041/2014)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
classism, socioeconomic status, social class, pain assessment, pain management, nurses, chronic low back pain
MeSH terms
Adult, Female, Humans, Male, Pain, Pain Measurement, Social Class, Low Back Pain, Pain Management, Racism

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