Perceived Discrimination in Health Care Is Associated With a Greater Burden of Pain in Sickle Cell Disease
Perceived Discrimination in Health Care Is Associated With a Greater Burden of Pain in Sickle Cell Disease
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DOI：
10.1016/j.jpainsymman.2014.02.002
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发表时间：
2014-11-01
影响因子：
4.7
通讯作者：
Beach, Mary Catherine
中科院分区：
文献类型：
--
作者：
Haywood, Carlton, Jr.;Diener-West, Marie;Beach, Mary Catherine
上下文。在一些少数族裔患者群体中，感知到的社会歧视经历与更高的疼痛负担有关。描述镰状细胞病(SCD)患者在多大程度上感受到来自卫生保健提供者的歧视，并检查这些经历与慢性SCD疼痛负担的关系。对SCD患者护理经历的前瞻性队列研究(n=291)基线收集的数据进行横断面分析。卫生保健提供者感知的基于种族和基于疾病的歧视是使用改编自关怀人际过程调查的子量表来衡量的。使用描述性、双变量和多变量分析技术，检验辨别分数与患者特征和疼痛负担测量的相关性。与非裔美国人之前报告的相比，受访者报告了来自医疗保健提供者的基于种族的歧视的负担更大，他们报告的基于疾病的歧视比基于种族的歧视更多。年龄和难以说服提供者接受疼痛是唯一与基于种族的歧视独立相关的患者特征，而年龄较大、急诊室利用率较高、难以说服提供者关于疼痛、每日慢性疼痛、一周内较少的好日子以及好日子里疼痛的严重程度与基于疾病的歧视较大独立相关。研究发现，感觉到的基于疾病而不是基于种族的歧视与SCD患者中更大范围的自我报告疼痛有关。如果是因果关系，这一发现可能标志着一种重要的新方法，以减轻SCD患者经历的疼痛负担。J疼痛症状管理2014；48：934-943。(C)2014年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Context. Perceived discriminatory experiences in society have been associated with a higher burden of pain among some minority patient populations.Objectives. To describe the extent to which patients with sickle cell disease (SCD) perceive discrimination from health care providers and to examine the association of these experiences with the burden of chronic SCD pain.Methods. Cross-sectional analysis of data collected at baseline of a prospective cohort study of SCD patient experiences of care (n = 291). Perceived race-based and disease-based discrimination from health care providers were measured using subscales adapted from the Interpersonal Processes of Care Survey. Discrimination scores were examined for their association with patient characteristics and measures of pain burden using descriptive, bivariate, and multivariate analytic techniques.Results. Respondents reported a greater burden of race-based discrimination from health care providers than has been previously reported by African Americans, and they reported a greater amount of disease-based vs. race-based discrimination. Age and having difficulty persuading providers about pain were the only patient characteristics independently associated with race-based discrimination, whereas older age, greater emergency room utilization, having difficulty persuading providers about pain, daily chronic pain, fewer good days during a week, and a higher severity of pain on their good days were independently associated with greater disease-based discrimination.Conclusion. Perceived disease-based, but not race-based, discrimination was found to be associated with a greater range of self-reported pain among patients with SCD. If causal, this finding could signal an important new approach to mitigating the burden of pain experienced by persons with SCD. J Pain Symptom Manage 2014; 48: 934-943. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.