Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship

Abstract

Compared to racism and sexism, classism in pain assessment and management practices (PAMP) has been less investigated and its mediating mechanisms are still unknown. Drawing upon a social psychological model of dehumanization, this research aimed to test: (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMP and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (Low vs. High) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/pictures depicting two cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement.Participants reported on patient dehumanization, perceived life hardship and PAMP. The Low SES patient was perceived as less pain sensitive (medical students only) but more disabled, credible and her pain more attributed to psychological causes (by nurses only). Medical students recommended less non-pharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the Low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students only). Perceived life hardship mediated SES effects on pain disability, credibility (nurses only) and intentions of providing individualized care (nurses only). These finding bear novel contributions to the fields of pain, health service research and social psychology, and have important implications to the development of more effective future interventions to reduce classism in PAMP.

Socioeconomic position and pain: a topical review

“…15 Of note, few studies have investigated the mediating mechanisms (eg, dehumanization, perceived life hardship) accounting for the effects of SEP on pain care leading to pain care disparities. 5,18,38…”

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia

“…This dominant individualising discourse may limit the acknowledgement of how broader societal systems, practices, and ideologies play a role not only in the prevalence and incidence of LBP 9,28 but in pain management. [29][30][31] For example, although LBP is considered a multidimensional condition that must be considered within a biopsychosocial approach, aspects such as institutional power relations, social determinants of pain, and cultural considerations are commonly sidelined. 4 Further, the biopsychosocial model itself has been critiqued for lowlighting socio-cultural-political accounts on health.…”

Public Chronic Pain Stigma and the Role of Pain Type and Patient Gender: An Experimental Vignette Study

“…Future research should aim to examine public chronic pain stigma from an intersectionality framework [58]. For instance, although some evidence suggests that the pain experiences of women of different social classes are assessed differently [6,22] the extent to which public stigma towards men/women of different ages, race/ethnicity, and/or SES differs is unknown. In order to examine important intersections of chronic pain stigma (i.e., other stigmatized identities evoking or further exacerbating stigma), recruiting more diverse samples is warranted.…”