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

基本信息

批准号：
10916670
负责人：
Nao Hagiwara
金额：
$ 40.3万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-18 至 2027-06-30
项目状态：
未结题

项目摘要

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).

尽管几十年来努力减少种族疼痛差异，但黑人患者的疼痛仍然没有得到充分治疗。作为持续性疼痛经历有力地预示着总体生活质量较差，种族疼痛护理差异代表了加剧社会不平等的核心因素。虽然之前的工作已经确定了许多患者和提供者总体上造成医疗保健方面种族差异并因此也可能造成差异的因素在疼痛护理方面，在消除这些差异方面取得的具有临床意义的进展有限。因此，有迫切需要采取创新方法来解决这种存在了数十年的不平等问题。我们认为这种缺乏取得进展的原因是之前的研究已经调查了患者和提供者因素的影响隔离，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，而建设性沟通既是二元的又是动态的。这项拟议的研究将建立医患沟通的二元动态流程作为关键患者和提供者因素导致患者和医疗服务提供者之间种族差异的机制集中和临床疼痛结果。这种二元过程的一种广为接受的操作是行为协调（即，行为节奏或模式的空间/时间匹配参与互动的个体，例如同步性、领导者和追随者动态以及轮流）。我们假设黑人患者的疼痛仍然得不到充分治疗，因为黑人（相对于白人）患者更有可能参与种族不和谐的医疗互动（即看其他种族的医疗服务提供者）并作为结果，更有可能经历行为协调的破坏。这些假设将被检验在术前咨询的背景下，因为手术疼痛结果的种族差异很大跨程序进行记录，此外，术前咨询的质量与术后相关疼痛管理。我们将使用收敛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（例如效价、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（总体咨询和具体的疼痛讨论期间）；目标2) 阐明患者/提供者因素与术前咨询协调之间的联系；和目标 3) 确定术前咨询中行为协调的具体方面，这些方面有助于种族歧视以患者为中心的术后结果的差异（例如疼痛管理自我效能、生活质量）以及临床结果（例如疼痛程度、处方）。由于这项研究的重点是疼痛管理自我效能和生活质量作为主要结果，研究结果将超越手术疼痛。拟议的工作将为制定针对可改变因素（潜在的二元过程）的干预措施奠定基础患者与提供者之间的沟通）可以通过利用现有基础设施（医疗培训）来解决。