(203) Effects of Patient and Provider Race and Socioeconomic Status on Pain Treatment Decisions and Decision-Making Awareness

Abstract

Decision-making in chronic pain care requires synthesizing complex information from many sources. Treatment guidelines have been described as “unclear and confusing,” which can lead to inconsistent pain care, non-clinically relevant information influencing decisions, and perpetuation of racial and socioeconomic disparities. Increased understanding of the factors influencing providers’ treatment decisions and the extent to which providers are aware of their decision-making process may help to reduce disparities and improve care. We used computer-simulated patients to examine the impact of provider and patient race (Black/White) and socioeconomic status (low/high) on providers’ treatment decisions. After making treatment decisions for twelve patients, providers rated the extent to which race and SES influenced their decisions. Repeated measures ANOVAs examined the extent to which providers demonstrated statistically reliable treatment differences across patient race and SES. Providers were then categorized by their reported use of patient race and patient SES while making treatment decisions. Although 41% of White providers and 31% of non-White providers demonstrated race-biased decision-making, only 6% of White providers and 10% of non-White providers reported using patient race in their decisions. A similar proportion of providers across three socioeconomic strata (low, medium, and high) demonstrated SES-biased decisions (41%, 43%, and 38%, respectively), and these rates were consistent with providers’ reported use of patient SES information (provider SES low: 44%, medium: 43%, and high: 48%). These results suggest providers have low awareness of making different pain treatment decisions for Black vs. White patients, whereas they have better awareness about their treatment decisions for low vs. high SES patients. Moreover, decision-making awareness did not substantially differ across provider race or SES. Future research is needed to determine the extent to which increasing providers’ decision-making awareness leads to better pain care. Supported by a grant from the National Institute on Minority Health and Health Disparities, USA (R01MD008931).