Sickle Cell Disease Bias: An Early Opportunity for Intervention?

Abstract

Background: Sickle cell disease (SCD) is a genetic condition leading to multi-organ dysfunction and chronic pain, with 1 out of 13 African Americans having the trait. Despite its prevalence and debilitating symptoms, SCD remains a disease with limited therapeutic interventions and decreased life expectancy. There is a clinical bias to undertreat the pain of patients with SCD with opioid medications, despite their effectiveness (Zempsky 2009). Early education about SCD may lead to improvements in provider perceptions and disease management.Methods: An anonymous survey was sent to first-year medical students at an academic institution prior to their hematology course. Data was collected about demographics, prior exposure to SCD, perceptions about opioid use disorder (OUD) in SCD, and baseline knowledge of management. Identical questions were asked for cancer-related pain. The survey was sent again after the completion of the hematology course to assess whether the curriculum was effective at characterizing misperceptions about patients with SCD.Results: Fifty-five medical students answered the survey prior to the course. Students were 38% male and 62% female. Seventy-five percent of students (N=41) had never encountered a patient with SCD. Forty percent (N=22) answered that OUD in patients with SCD is more likely, 60% as likely (N=33), and 0% less likely than the general population. Seventy-one percent (N=39) believed opiates should play a minor role, 5% (N=3) a major role, and 24% (N=13) said opioids should be avoided when managing SCD-related pain. After course completion, 35 students who had completed the survey prior to the course responded, 29% male and 71% female. Fifty-four percent (N=19) answered that OUD in patients with SCD is more likely, 43% (N=15) as likely, and 3% (N=1) less likely than the general population. Seventy-one percent (N=25) thought opiates should play a minor role, 9% (N=3) a major role, and 20% (N=7) said they should be avoided when managed SCD-related pain.Conclusion: After course completion, a higher percentage of medical students thought that OUD was more frequent in patients with SCD than the general population, with a similarly high percentage determining that opioid medications should play a minor role or be avoided in SCD. Opioid medications are an important part of treatment for SCD, especially for acute vaso-occlusive pain. Patients with SCD are no more likely to have OUD than the general population and have a lower rate of OUD than other patients with chronic pain conditions (Solomon 2008). This pilot study highlights that there is an opportunity to intervene in misperceptions of patients with SCD in early medical school education. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.