Examining the effects of contextually-imposed cognitive load on providers' chronic pain treatment decisions for racially and socioeconomically diverse patients

项目总结/摘要 与白色和社会经济地位高的人相比，黑人和 SES低的人经历更大的疼痛和残疾，更有可能接受次优的疼痛护理。一 造成这些差异的潜在因素是有偏见的供应商决策。有令人信服的证据表明 提供者在做出治疗决定时受到患者种族和社会经济地位的影响。疼痛是主观的， 提供者经常在信息不足的情况下做出疼痛护理决定。因此，供应商可以填写这些 关于种族和SES群体的刻板印象的信息差距，导致疼痛护理的系统性差异。 根据双重过程模型（dual process model，简称dim）和以往的研究，人们更倾向于使用 当他们处于高认知负荷下时的刻板印象（即，心理负荷）。卫生保健设置高 通过时间压力、噪音水平和干扰对提供者的认知需求。另一个可能 有助于偏见的提供者决策是隐含的信念（潜意识，自动刻板印象）， 与医疗保健的不平等有关。一个与疼痛护理相关的刻板印象是 黑人和社会经济地位低的人更能忍受疼痛。以前的研究表明，许多供应商持有 这些关于疼痛耐受力的信念与此相一致的是，处于高认知负荷下的供应商， 那些坚信黑人和低社会经济地位的人更能忍受疼痛的人可能特别有可能 建议对黑人和低SES患者减少疼痛治疗。为了验证这些假设， 这项研究将招募住院医生和研究员观看视频，并做出12年的疼痛治疗决定 计算机模拟的腰痛患者，不同种族（黑人/白色）和SES（低/高）;治疗 选择将包括止痛药物，补充和替代方法，生活方式的改变， 转介专科护理。一半的供应商将被随机分配到高认知负荷组， 他们将在治疗决策任务期间被中断以进行吗啡等效剂量转换。 在治疗决策任务期间，控制组中的提供者不会被打断。提供者的隐式 关于种族和SES疼痛耐受性差异的信念将用内隐关联测试来测量。的 主要分析将检查患者种族和SES对提供者治疗的主要影响和相互作用 慢性疼痛的决定（目的1），检查患者种族[SES]和认知的主要和相互作用的影响， 加载供应商的治疗决策（目标2），并检查患者种族的主要影响和交互影响 [SES]认知负荷和供应商对种族[SES]疼痛耐受差异的内隐信念， 提供者的治疗决定（目标3）。多层次模型将允许检查这些影响， 个人提供者和团体级别。拟议的研究具有高度创新性，是 消除疼痛护理中的差异。最终，该项目的研究结果可能会导致基于证据的干预措施 针对认知负荷和有偏见的提供者信念，从而减少差异。

Project Summary/Abstract Compared to individuals who are White and have high socioeconomic status (SES), those who are Black and have low SES experience greater pain and disability and are more likely to receive suboptimal pain care. One potential contributor to these disparities is biased provider decision-making. There is compelling evidence that providers are influenced by patient race and SES when making treatment decisions. Pain is subjective, and providers often make pain care decisions with insufficient information. Consequently, providers may fill these information gaps with stereotypes about race and SES groups, leading to systematic differences in pain care. According to the dual process model (DPM) and previous studies, people are more likely to use such stereotypes when they are under high cognitive load (i.e., mental workload). Health care settings place high cognitive demands on providers via time pressures, noises levels, and interruptions. Another factor that may contribute to biased provider decision-making is implicit beliefs (subconscious, automatic stereotyping), which have been found to be associated with health care disparities. One stereotype belief relevant to pain care is that Black and low SES individuals are more pain tolerant. Previous studies suggest that many providers hold these beliefs about pain tolerance. Consistent with the DPM, providers who are under high cognitive load and who have strong beliefs that Black and low SES people are more pain tolerant may be particularly likely to recommend fewer pain treatments for Black and low SES patients. To test these hypotheses, the proposed study will recruit physician residents and fellows to view videos and make pain treatment decisions for 12 computer-simulated patients with low back pain that vary by race (Black/White) and SES (low/high); treatment options will include analgesic medications, complementary and alternative approaches, lifestyle changes, and referrals to specialty care. Half of the providers will be randomized to the high cognitive load group in which they will be interrupted during the treatment decision task to make Morphine Equivalent Dose conversions. Providers in the control group will not be interrupted during the treatment decision task. Providers’ implicit beliefs about race and SES differences in pain tolerance will be measured with Implicit Association Tests. The primary analyses will examine the main and interaction effects of patient race and SES on providers’ treatment decisions for chronic pain (aim 1), examine the main and interaction effects of patient race [SES] and cognitive load on providers’ treatment decisions (aim 2), and examine the main and interaction effects of patient race [SES], cognitive load, and providers’ implicit beliefs about race [SES] differences in pain tolerance on providers’ treatment decisions (aim 3). Multilevel modeling will allow for the examination of these effects at the individual provider and group levels. The proposed study is highly innovative and represents a crucial step in combating disparities in pain care. Ultimately, the project findings may lead to evidence-based interventions that target cognitive load and biased provider beliefs and thereby reduce disparities.