Understanding the Provider Contribution to Race/Ethnicity Disparities in Pain Treatment: Insights from Dual Process Models of Stereotyping

Abstract

This article applied dual process models of stereotyping to illustrate how various psychological mechanisms may lead to unintentional provider bias in decisions about pain treatment. Stereotypes have been shown to influence judgments and behaviors by two distinct cognitive processes, automatic stereotyping and goal-modified stereotyping, which differ both in level of individual conscious control and how much they are influenced by the goals in an interaction. Although these two processes may occur simultaneously and are difficult to disentangle, the conceptual distinction is important because unintentional bias that results from goal-modified rather than automatic stereotyping requires different types of interventions. We proposed a series of hypotheses that showed how these different processes may lead providers to contribute to disparities in pain treatment: 1) indirectly, by influencing the content and affective tone of the clinical encounter; and 2) directly, by influencing provider decision making. We also highlighted situations that may increase the likelihood that stereotype-based bias will occur and suggested directions for future research and interventions.

Defining Racial and Ethnic Disparities in Pain Management

“…Rather, it is to focus consideration on the reality that many physicians, like others, are capable of simultaneously strongly advocating for racial/ethnic dignity and equality and maintaining stereotypic, negative racial prejudices and beliefs that exist outside of conscious awareness but still influence demeanor and behavior in the clinical setting [16,32,97,98]. This phenomenon, the existence of two types of social cognitions within the same individual, has been studied extensively by social cognitive psychologists [27,85] and, more recently, pain researchers [15,17]. This work has yielded a scientifically grounded explanatory model of social cognitive processing characterized by ''dual-system models'' in which social cognitions and related behaviors are seen as a function of two mental processing systems that are interconnected but operate according to different principles and meet different cognitive needs [17,85].…”

“…This phenomenon, the existence of two types of social cognitions within the same individual, has been studied extensively by social cognitive psychologists [27,85] and, more recently, pain researchers [15,17]. This work has yielded a scientifically grounded explanatory model of social cognitive processing characterized by ''dual-system models'' in which social cognitions and related behaviors are seen as a function of two mental processing systems that are interconnected but operate according to different principles and meet different cognitive needs [17,85]. Moreover, the model suggests each aspect of the model has a unique memory system [15,85].…”

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

“…However, when patients are upset, physicians sometimes respond in problematic ways, ranging from avoidance, to anger, to using stereotypes as a form of distancing. [68][69][70] And studies show that physicians' specific professional biases may lessen their ability to see patients' situations clearly, for example, when they are overly influenced by the memory of a rare bad outcome. 65,71 Therefore, physicians are likely to better address patients' emotional needs if they incorporate tools for reflective self-awareness into their practices.…”

Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

“…Evidence suggests that race may affect providers' conscious and unconscious beliefs about and expectations from patients [33,34]. In turn, these beliefs might lead to biases in providers' interpretation of symptoms and treatment decisions [6,32,33]. In many institutions, a primary care provider usually initiates the surgical referral for patients.…”