New Research Implicates Providers’ Beliefs About Biological Differences

New research from the University of Virginia suggests that elements of racial bias by providers may be at least partly implicated in disparities in pain treatment between black and white patients. Prior research has already documented a systematic undertreatment for pain among black Americans, both relative to whites, and also compared to World Health Organization guidelines. The study found that a substantial proportion of medical students and residents who were white held false beliefs about biological traits of blacks that could impact their assessment and treatment decisions for black patients with pain. These included the belief that blacks had thicker skin, that their blood coagulates faster, and that their nerve endings are less sensitive. Lead investigator Kelly Hoffman, a UVA psychology PhD candidate said “Many previous studies have shown that black Americans are undertreated for pain compared to white Americans, because physicians might assume black patients might abuse the medications or because they might not recognize the pain of their black patients in the first place. Our findings show that beliefs about black-white differences in biology may contribute to this disparity.” The findings are published online in the journal Proceedings of the National Academy of Sciences.

In the study, 222 white medical students and residents were given 2 mock presentations to evaluate, a leg fracture and a kidney stone, in both a white and black patient. The subjects were asked to rate the pain levels they would associate with the cases, and to devise pain treatment plans based on the rating. They were also asked to mark various beliefs about white/black biological difference as true or false.  50% of the study group endorsed at least one of the false beliefs, and those who did were more likely to report lower pain ratings for the black vs. white patient, and were less accurate in their treatment recommendations for the black vs. white patient. Hoffman noted that the cohort who did not hold false beliefs also did not evidence racial bias in their treatment recommendations, and suggested that further work is needed to test whether challenging these beliefs may lead to better treatment outcomes for black patients. Read a news story from UVA about the research findings here. The journal abstract may be found here.

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