Clinician–Patient Racial/Ethnic Concordance Influences Racial/Ethnic Minority Pain: Evidence from Simulated Clinical Interactions

• Published in: Pain medicine (Malden, Mass.) Vol. 21; no. 11; pp. 3109 - 3125
• Main Authors: Anderson, Steven R, Gianola, Morgan, Perry, Jenna M, Losin, Elizabeth A Reynolds
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2020
• Subjects: African Americans; Arousal; Ethnicity; General & Selected Populations Section; Health aspects; Health care disparities; Hispanic Americans; Hispanic or Latino; Humans; Influence; Medical personnel and patient; Medical research; Medicine, Experimental; Minorities; Minority & ethnic groups; Minority Groups; Pain; Patients; Physiology; Risk factors; Social aspects; United States; Whites; United States; Health Disparities; Pain Report; Clinician–Patient; Racial/Ethnic Concordance
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnaa258

Abstract Objective Racial and ethnic minorities in the United States report higher levels of both clinical and experimental pain, yet frequently receive inadequate pain treatment. Although these disparities are well documented, their underlying causes remain largely unknown. Evidence from social psychological and health disparities research suggests that clinician–patient racial/ethnic concordance may improve minority patient health outcomes. Yet whether clinician–patient racial/ethnic concordance influences pain remains poorly understood. Methods Medical trainees and community members/undergraduates played the role of “clinicians” and “patients,” respectively, in simulated clinical interactions. All participants identified as non-Hispanic Black/African American, Hispanic white, or non-Hispanic white. Interactions were randomized to be either racially/ethnically concordant or discordant in a 3 (clinician race/ethnicity) × 2 (clinician–patient racial/ethnic concordance) factorial design. Clinicians took the medical history and vital signs of the patient and administered an analogue of a painful medical procedure. Results As predicted, clinician–patient racial/ethnic concordance reduced self-reported and physiological indicators of pain for non-Hispanic Black/African American patients and did not influence pain for non-Hispanic white patients. Contrary to our prediction, concordance was associated with increased pain report in Hispanic white patients. Finally, the influence of concordance on pain-induced physiological arousal was largest for patients who reported prior experience with or current worry about racial/ethnic discrimination. Conclusions Our findings inform our understanding of the sociocultural factors that influence pain within medical contexts and suggest that increasing minority, particularly non-Hispanic Black/African American, physician numbers may help reduce persistent racial/ethnic pain disparities.