Racial/Ethnic Disparities in the Assessment and Treatment of Pain Psychosocial Perspectives
Racial/Ethnic Disparities in the Assessment and Treatment of Pain Psychosocial Perspectives
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DOI：
10.1037/a0035204
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发表时间：
2014-02-01
影响因子：
16.4
通讯作者：
Chibnall, John T.
中科院分区：
文献类型：
--
作者：
Tait, Raymond C.;Chibnall, John T.
种族/民族差异不仅在整个美国医疗保健系统中普遍存在，而且事实证明难以改变。在慢性疼痛患者的治疗中，这种差异是显而易见的，并且同样持续存在，导致个人和社会成本高昂。虽然心理社会因素对这个棘手的问题有很大影响，但缺乏对文献的综合检查。本文概述了导致慢性疼痛患者治疗和疼痛调整差异的心理社会因素。它最初侧重于可能引起不同护理的疼痛评估方面。由于疼痛是一种主观现象，常常无法进行客观的医学评估，因此它特别容易受到社会心理的影响，例如刻板印象。我们特别关注负面的种族/民族刻板印象以及可能引发刻板印象驱动判断的情况。随后的部分回顾了可能影响患者疼痛体验的社会心理因素、影响患者与提供者互动的因素以及在公共卫生环境中发挥作用的因素。在每个部分之后，我们建议可以解决与临床护理、研究和政策相关的已识别问题的行动。政策建议通常与《平价医疗法案》的条款相关。最后，我们讨论了心理学在未来解决疼痛护理中持续存在的种族/民族差异问题中应发挥的作用。
Racial/ethnic disparities not only are prevalent throughout the U. S. health care system but also have proved refractory to change. Such disparities are evident and similarly persistent in the treatment of patients with chronic pain conditions, exacting high personal and societal costs. While psychosocial factors contribute significantly to this intractable problem, an integrated examination of the literature is lacking. This article provides an overview of psychosocial factors that contribute to disparities in the treatment of chronic pain patients and in their adjustment to pain. It focuses initially on aspects of pain assessment that can occasion disparate care. Because pain is a subjective phenomenon that often defies objective medical assessment, it is particularly susceptible to social psychological influences, such as stereotypes. We pay particular attention to negative racial/ethnic stereotypes as well as to the circumstances that are likely to trigger stereotype-driven judgments. Subsequent sections review psychosocial factors that can influence a patient's experience of pain, those that can influence the patient-provider interaction, and those that operate in the public health environment. After each section, we suggest actions that could address identified issues related to clinical care, research, and policy. Policy recommendations generally are linked to provisions of the Affordable Care Act. We conclude with a discussion of the role that psychology should play in future efforts to address the persistent problem of racial/ethnic disparities in pain care.