Racial Disparities in Pain Care: A Comprehensive Integration of Patient- and Provider-Level Mechanisms with Dyadic Communication Processes Using a Mixed-Methods Research Design

疼痛护理中的种族差异：使用混合方法研究设计将患者和提供者层面的机制与二元沟通过程进行全面整合

• 批准号: 10446762
• 负责人: Nao Hagiwara
• 金额: $ 50.19万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2023-08-10
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10446762
• 关键词: Address; Agreement; Back; Behavior; Behavioral; Black race; COVID-19; Caring; Clinical; Communication; Consultations; Data Analyses; Empathy; Fibrinogen; Foundations; Goals; Individual; Infrastructure; Integration Host Factors; Intervention; Knowledge; Link; Medical; Methodology; Modeling; Operative Surgical Procedures; Outcome; Pain; Pain management; Patient-Focused Outcomes; Patients; Pattern; Persistent pain; Persons; Postoperative Pain; Prejudice; Procedures; Process; Provider; Quality of life; Race; Recurrence; Research; Research Design; Research Methodology; Self Efficacy; Stereotyping; Surgeon; Surveys; Techniques; Testing; Training; Transcript; Trust; United States National Institutes of Health; Video Recording; Work; black patient; clinical pain; disparity elimination; dynamic system; experience; frontier; health care disparity; innovation; multiple data sources; pain outcome; pain perception; pain self-management; patient oriented; patient-clinician communication; perceived discrimination; primary outcome; provider factors; racial disparity; recruit; satisfaction; secondary outcome; social inequality; surgical pain; telehealth

Despite decades of efforts to reduce racial pain disparities, the pain of Black patients is still undertreated. As persistent pain experience robustly predicts poorer quality of life overall, racial pain care disparities represent a central factor fueling larger social inequalities. While previous work has identified a host of patient and provider factors that contribute to racial disparities in healthcare in general and thus also likely contributing to disparities in pain care, there has been limited clinically-meaningful progress in eliminating these disparities. Thus, there is an urgent need to address this decades-old inequity by taking an innovative approach. We argue that this lack of progress is due to the fact that prior research has investigated the influence of patient and provider factors in isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider communication, and constructive communication is both dyadic and dynamic. This proposed research will establish the dyadic and dynamic processes underlying patient-provider communication as the key mechanism through which patient and provider factors contribute to racial disparities in both patient- centered and clinical pain outcomes. One well-accepted operationalization of such dyadic processes is behavioral coordination (i.e., spatial/temporal matching in the rhythms or patterns of behaviors between individuals engaged in an interaction, such as synchrony, leader-and-follower dynamics, and turn-taking). We hypothesize that the pain of Black patients continues to be undertreated because Black (vs. White) patients are more likely to participate in racially discordant medical interactions (i.e., seeing other-race providers) and as a result, are more likely to experience disruptions in behavioral coordination. These hypotheses will be tested within the context of preoperative consultations because racial disparities in surgical pain outcomes are well- documented across procedures, and further, the quality of preoperative consultations is linked to post-surgical pain management. We will use a convergent mixed methods research design to assess behavioral coordination quantitatively (e.g., levels, duration, patterns) and qualitatively (e.g., valence, discussion themes). This work will: Aim 1) compare the levels, duration, patterns, and context of behavioral coordination in preoperative consultations (both overall and during pain discussion specifically) between Black and White patients; Aim 2) elucidate links between patient/provider factors and coordination in preoperative consultations; and Aim 3) identify specific aspects of behavioral coordination in preoperative consultations that contribute to racial disparities in post-surgical patient-centered outcomes (e.g., pain management self-efficacy, quality of life) and clinical outcomes (e.g., pain level, prescriptions). Since this research focuses on pain management self-efficacy and quality of life as primary outcomes, findings will be generalizable beyond surgical pain. The proposed work will lay the foundation for developing interventions that target modifiable factors (the dyadic processes underlying patient-provider communication) that can be addressed by leveraging existing infrastructure (medical training).

尽管几十年来减少种族疼痛差异的努力，但黑人患者的疼痛仍然不足。作为 持续的疼痛经历强烈预测整体生活质量较差，种族疼痛护理差异代表 中心因素加剧了更大的社会不平等。虽然先前的工作已经确定了许多患者和提供者 总体上导致种族差异的因素，因此也可能导致差异 在疼痛护理中，在消除这些差异方面取得了限制的临床意义进展。因此，有 迫切需要通过采取创新方法来解决这一历史了数十年的不平等。我们认为这缺乏 进步的是由于以下事实，即先前的研究调查了患者和提供者因素在 隔离，而不是检查它们的相互作用。成功的疼痛护理需要建设性的患者提供者 沟通和建设性的交流既是二元又动态的。这项拟议的研究将 建立患者支持者沟通为关键的二元和动态过程 患者和提供者因素导致两位患者种族差异的机制 - 中心和临床疼痛结果。此类二元过程的一个经过广泛接受的操作是 行为协调（即，在节奏或行为模式中的空间/时间匹配 从事互动的个人，例如同步，领导者动态和转弯）。我们 假设黑人患者的疼痛仍然不足，因为黑人（与白人）患者是 更有可能参与种族不一致的医学互动（即看到其他赛道提供者），并且 结果，更有可能在行为协调中遭受中断。这些假设将进行测试 在术前咨询的背景下，因为手术疼痛结果的种族差异是很好的 跨程序进行了记录，此外，术前咨询的质量与后手术有关 疼痛管理。我们将使用收敛的混合方法研究设计来评估行为协调 定量（例如，水平，持续时间，模式）和定性（例如价，讨论主题）。这项工作将： 目标1）比较术前行为协调的水平，持续时间，模式和背景 黑人和白人患者之间的咨询（整体和疼痛讨论期间）；目标2） 在术前咨询中阐明患者/提供者因素与协调之间的联系；和目标3） 在术前咨询中确定行为协调的特定方面，这有助于种族 手术后以患者为中心的结果（例如疼痛管理自我效能感，生活质量）和 临床结果（例如，疼痛水平，处方）。由于这项研究重点是疼痛管理自我效能感 和生活质量作为主要结果，在手术疼痛之外的发现将是可以推广的。拟议的工作 将奠定针对可修改因素的干预措施的基础（基础的二元过程 可以通过利用现有的基础设施（医学培训）来解决的患者提供沟通）。