Purdue University Graduate School
Thesis_Complete_Formatted_Anastas_submit.pdf (1.02 MB)

The Influence of Patient Race and Socioeconomic Status on Providers' Assessment and Treatment Recommendations for Chronic Pain

Download (1.02 MB)
posted on 2019-06-10, 17:36 authored by Tracy Marie AnastasTracy Marie Anastas

Compared to White and high socioeconomic (SES) patients, Black and low SES patients are less likely to receive adequate pain care, including receiving fewer analgesic medications. Providers may, inadvertently or not, contribute to these disparities in pain care via biased decision-making. Prior work suggests there is a complex relationship in which race and SES uniquely and interactively affect providers’ clinical decisions, but few studies have examined the influence of patient race and SES simultaneously on providers’ pain-related decisions. Furthermore, previous studies suggest that providers’ attitudes about race and SES influence their clinical decisions. The present study examined the influence of patient race and SES and providers’ implicit and explicit attitudes about race and SES on providers' pain-related decisions. Four hundred and seven medical residents and fellows made pain assessment (interference and distress) and treatment (opioids, opioid contracts, and workplace accommodations) decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Subjects completed Implicit Association Tests to assess implicit attitudes and feeling thermometers to assess explicit attitudes about race and SES. Repeated measures ANOVAs indicated that patient race and/or SES had main effects on all pain-related decisions and had interaction effects on providers’ ratings for interference, distress, and workplace accommodations. Providers’ implicit attitudes about race and explicit attitudes about race and SES predicted their pain-related decisions, but these effects were not consistent across all decisions. The current study highlights the need to examine the effects of patient race and SES together, along with providers’ implicit and explicit attitudes, in the context of pain care. Results inform future work that can lead to the development of evidence-based interventions to reduce disparities in pain care.


National Institute on Minority Health and Health Disparities, USA (R01MD008931)


Degree Type

  • Master of Science


  • Psychological Sciences

Campus location

  • Indianapolis

Advisor/Supervisor/Committee Chair

Adam Hirsh, PhD

Additional Committee Member 2

Jesse Stewart, PhD

Additional Committee Member 3

Kevin Rand, PhD

Usage metrics



    Ref. manager