The Faces Pain Scale-Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.
Introduction: Physician bias impacts clinical decision making, resulting in disparities in patient care. Most existing studies focus on sex and racial bias. This study aimed to investigate disparities in physician decision making among patients of varying socioeconomic status (SES). Methods: Emergency medicine residents (n = 31) participated in 3 consecutive scenarios of similar disease acuity but with standardized patients of varying SES. Following the scenarios, residents met with a standardized participant acting as an attending physician for a handoff to recount their decision-making processes and care recommendations. Blinded raters evaluated clinical performance using an objective assessment tool. We assessed associations between patient SES and resident-ordered imaging, ordered medication, patient-perceived empathy, and clinical performance. We used qualitative analyses to study residents' decision-making processes. Results: Quantitative analyses revealed no significant relationship between SES and resident-ordered imaging, ordered medications, patient-perceived empathy, and clinical performance. Qualitative analyses revealed 3 themes regarding clinical decision making:(1) overt diagnostic focus, (2) discharge planning, and (3) risk and exposure. Conclusions: Although quantitative analyses showed that SES did not affect clinical behavior within simulated scenarios, qualitative analyses uncovered 3 themes believed important to physician decision-making processes. Overt diagnostic focus may have resulted from the study environment in addition to organizational factors, policies, and training. Discharge planning, which was not explicitly studied, was often tailored to SES with emphasis placed on risks for patients of low SES. Further research is needed to uncover the nuances of bias, SES, and physician decision making throughout the patient care continuum and within various clinical environments.
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