The objective of the proposed project is to test a novel perspective-taking intervention aimed at reducing racial and SES disparities in pain treatment. Previous studies found that Black and low SES patients are less likely to receive guideline-concordant pain care relative to White and high SES patients, respectively. Studies also found that clinicians contribute to these treatment disparities, which directly impact patient outcomes. Few interventions effectively reduce racial and SES disparities in pain treatment. Interventions that target clinicians are especially scarce. According to research and theory, enhancing clinician perspective-taking is a promising strategy for improving the care of Black and low SES patients, and this strategy should be pursued during medical training to maximize its effectiveness. Unfortunately, there are numerous limitations and practical constraints to traditional perspective-taking interventions, which reduce their implementation and effectiveness. To overcome these barriers, we developed an innovative methodology that utilizes computer-simulated patients and environments to assess, understand, and remediate pain treatment disparities. In the proposed project, we aim to leverage this approach to test a theoretically-informed, evidence-based intervention to reduce racial and SES disparities in pain treatment. Using computer-simulated patients and environments, our intervention provides real-time feedback to trainees about their pain treatment biases, includes one-on-one interactions with virtual patients with pain, and includes videos of these patients engaging in daily life activities with pain. Our approach allows for the intervention to be individually-tailored to each trainee, thereby enhancing its impact. It also allows for individual trainees to gain exposure to a greater range of racially and socioeconomically diverse patients than can normally be obtained in traditional training settings. Based on previous research and sound theory, we hypothesize that our perspective-taking intervention will increase trainees'knowledge of their own biases, enhance trainees'empathy toward patients, and reduce trainees'anxiety/threat toward patients, and that these changes will be the primary mechanisms underlying reductions in pain treatment disparities. This project represents a critical next step in the nation's goal of reducing racial ad SES disparities and improving pain care. Our intervention could be readily incorporated into medical school and continuing education curricula for widespread dissemination. Our approach could also be leveraged to reduce disparities for other conditions of public health significance, such as cancer, cardiovascular disease, and diabetes. Given that clinicians are key participants in patient care and are a primary source of health disparities, the proposed project has direct implications for improving care for vulnerable patients. This project will also inform scientific understanding of the mechanisms (e.g., bias awareness, patient empathy, patient anxiety/threat) underlying treatment disparities, as well as medical education to enhance the delivery of equitable, patient-centered care.

Public Health Relevance

This project addresses an important societal issue and represents a critical next step in the nation's goal of reducing health disparities and improving pain care. The results will have direct implications for patient care, medical education, and scientific understanding of racial and socioeconomic disparities in pain treatment.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZMD1)
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Alvidrez, Jennifer L
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Indiana University-Purdue University at Indianapolis
Schools of Arts and Sciences
United States
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Hollingshead, Nicole A; Ashburn-Nardo, Leslie; Stewart, Jesse C et al. (2016) The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model. J Pain 17:513-28
Meints, Samantha M; Miller, Megan M; Hirsh, Adam T (2016) Differences in Pain Coping Between Black and White Americans: A Meta-Analysis. J Pain 17:642-53
Hollingshead, Nicole A; Meints, Samantha M; Miller, Megan M et al. (2016) A comparison of race-related pain stereotypes held by White and Black individuals. J Appl Soc Psychol 46:718-723
Hirsh, Adam T; Hollingshead, Nicole A; Ashburn-Nardo, Leslie et al. (2015) The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions. J Pain 16:558-68