Virtual Perspective-Taking to Reduce Race and SES Disparities in Pain Care

描述(由申请人提供)：拟议项目的目标是测试一种新的视角采取干预措施，旨在减少疼痛治疗中的种族和SES差异。先前的研究发现，与白人和高SES患者相比，黑人和低SES患者分别不太可能接受符合指南的疼痛护理。研究还发现，临床医生造成了这些治疗差异，这直接影响了患者 结果。很少有干预措施能有效地减少疼痛治疗中的种族和社会性别差异。针对临床医生的干预措施尤其稀少。根据研究和理论，加强临床医生的观点采择是改善黑人和低SES患者护理的一种有前途的策略，这一策略应该在医学培训中实施，以最大化其有效性。不幸的是，传统的采取观点的干预措施存在许多限制和实际制约，这降低了其执行和有效性。为了克服这些障碍，我们开发了一种创新的方法，利用计算机模拟的患者和环境来评估、了解和补救疼痛治疗差异。在拟议的项目中，我们的目标是利用这种方法来测试一种理论上知情的、基于证据的干预措施，以减少疼痛治疗中的种族和SES差异。使用计算机模拟的患者和环境，我们的干预措施向受训者提供关于他们的疼痛治疗偏见的实时反馈，包括与虚拟疼痛患者的一对一互动，并包括这些患者参与疼痛日常生活活动的视频。我们的方法允许为每个受训人员量身定做干预措施，从而增强其影响。它还允许个别受训人员接触到 与传统培训环境中通常可以获得的患者相比，种族和社会经济多样化的患者范围更广。基于先前的研究和可靠的理论，我们假设我们的观点采取干预将增加受训者对自己偏见的认识，增强受训者对患者的同理心，并减少受训者对患者的焦虑/威胁，这些变化将是减少疼痛治疗差异的主要机制。这个项目代表着国家缩小种族差异和改善疼痛护理的关键下一步。我们的干预措施可以很容易地纳入医学院和继续教育课程，以便广泛传播。我们的方法也可以被用来减少其他对公共卫生有意义的疾病的差异，如癌症、心血管疾病和糖尿病。鉴于临床医生是患者护理的关键参与者，也是健康差距的主要来源，拟议的项目对改善对脆弱患者的护理具有直接影响。该项目还将促进对治疗差异的潜在机制(例如，偏见意识、患者同理心、患者焦虑/威胁)的科学理解，以及促进提供公平的、以患者为中心的护理的医学教育。

DESCRIPTION (provided by applicant): The objective of the proposed project is to test a novel perspective-taking intervention aimed at reducing racial and SES disparities in pain treatment. Previous studies found that Black and low SES patients are less likely to receive guideline-concordant pain care relative to White and high SES patients, respectively. Studies also found that clinicians contribute to these treatment disparities, which directly impact patient outcomes. Few interventions effectively reduce racial and SES disparities in pain treatment. Interventions that target clinicians are especially scarce. According to research and theory, enhancing clinician perspective-taking is a promising strategy for improving the care of Black and low SES patients, and this strategy should be pursued during medical training to maximize its effectiveness. Unfortunately, there are numerous limitations and practical constraints to traditional perspective-taking interventions, which reduce their implementation and effectiveness. To overcome these barriers, we developed an innovative methodology that utilizes computer-simulated patients and environments to assess, understand, and remediate pain treatment disparities. In the proposed project, we aim to leverage this approach to test a theoretically-informed, evidence-based intervention to reduce racial and SES disparities in pain treatment. Using computer-simulated patients and environments, our intervention provides real-time feedback to trainees about their pain treatment biases, includes one-on-one interactions with virtual patients with pain, and includes videos of these patients engaging in daily life activities with pain. Our approach allows for the intervention to be individually-tailored to each trainee, thereby enhancing its impact. It also allows for individual trainees to gain exposure to a greater range of racially and socioeconomically diverse patients than can normally be obtained in traditional training settings. Based on previous research and sound theory, we hypothesize that our perspective-taking intervention will increase trainees' knowledge of their own biases, enhance trainees' empathy toward patients, and reduce trainees' anxiety/threat toward patients, and that these changes will be the primary mechanisms underlying reductions in pain treatment disparities. This project represents a critical next step in the nation's goal of reducing racial ad SES disparities and improving pain care. Our intervention could be readily incorporated into medical school and continuing education curricula for widespread dissemination. Our approach could also be leveraged to reduce disparities for other conditions of public health significance, such as cancer, cardiovascular disease, and diabetes. Given that clinicians are key participants in patient care and are a primary source of health disparities, the proposed project has direct implications for improving care for vulnerable patients. This project will also inform scientific understanding of the mechanisms (e.g., bias awareness, patient empathy, patient anxiety/threat) underlying treatment disparities, as well as medical education to enhance the delivery of equitable, patient-centered care.