Taking into account the observers’ uncertainty: a graduated approach to the credibility of the patient’s pain evaluation

Abstract

1 AcknowledgementsAuthors wish to thank John Burns and three unknown referees for their pertinent comments and suggestions. We are also grateful to Marco Marelli for his suggestions on the analyses of the properties of the graduated approach used in Experiment 2. 1 AbstractThis article presents two experiments aiming to investigate the adoption of a graduated measure to describe credibility attribution by observers who evaluate patients' pain accounts. A total of 160 medical students were required to express a credibility judgment on the pain intensity level of hypothetical patients. We used 16 vignettes based on a factorial mixed-design. Withinparticipants factors were the reported pain, the presence of a physical sign, the patient's facial expression and the patient's gender, and between-groups factors were the patient's age and the geographical distribution of the patient's name. Results confirm the well-established tendency not to believe patients' self-reports and provide information regarding the evaluators' uncertainty. The findings suggest that a graduated measure is useful for assessing the degree of uncertainty of the observers and subtle effects of different factors upon the judgment of patient's pain.

The Influence of Anchoring on Pain Judgment

“…In this regard, there remains a lack of empirical research on the cognitive underpinnings of pain miscalibration. 11e13, 49 The present study is an attempt to unveil a cognitive process that might intervene in pain assessment. We focused on the use of a readily accessible heuristic, namely anchoring and adjustment, whereby people rely excessively on an initial impression and interpret subsequent incoming evidence with reference to that impression.…”

Empirical Review Supporting the Application of the “Pain Assessment as a Social Transaction” Model in Pediatrics

“…54 Uncertainty in accepting or acting on individual self-reports is particularly increased in the presence of high pain scores and ambiguous behavioral or physical signs or symptoms. 52,54 These findings are not surprising, given that a large part of general interpersonal communication is nonverbal.…”

“…51 This finding is similar to a study of medical students who believed the patient's pain report to be credible in only 45% of cases. 52 In another survey, 55% of pediatric nurses reported that at least 20% of children likely overreport their pain. 53 Potential reasons for discordant judgments include incongruent presentation, provider uncertainty, and provider bias.…”

Gender differences in the experience of pain dismissal in adolescence

“…Additionally, research has demonstrated that women are less likely to get appropriate referrals when presenting with chronic pain of an unknown etiology (Stalnacke et al, 2015). Furthermore, female pain intensity is less likely to be believed, even when presenting with similar physical signs as males (Rusconi et al, 2010).…”