Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

Abstract

Objective Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses’ pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices. Design Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design. Subjects Female nurses participated in two experimental studies (N = 150/N = 158). Methods Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices. Results The low-SES patient’s pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient’s pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices. Conclusions Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

Factors associated with the experience of patients presenting in pain to the emergency department

“…Association between SES and pain care are well described in the literature, especially in regard to chronic pain care, with patients from lower SES neighbourhoods more likely to develop chronic pain, and be prescribed opiate medications (Booher, 2019; Gebauer et al., 2017). In experimental studies, nurses have been shown to assess patients with low SES as having less intense pain and patients reports of pain less credible (Brandão et al., 2019); however, exact causal relationships in the ED have not been documented and will require further investigation.…”

The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review

“… 71 , 378 , 379 Patients with lower SES and chronic pain have been viewed by health care providers to be less competent and compliant in the use of medications and other multidisciplinary therapies for pain. 163 , 369 They have been thought by physicians to have less self-control over medication use with a greater propensity to misuse opioids and so studies have found that physicians disproportionately require them to complete opioid contracts compared to patients with higher SES. 59 , 273 , 369 , 380 Patients with lower SES have been considered by health care providers to be more “demanding,” 163 (p2094) and their pain has been referred to in “dehumanizing” ways.…”

“… 163 , 369 They have been thought by physicians to have less self-control over medication use with a greater propensity to misuse opioids and so studies have found that physicians disproportionately require them to complete opioid contracts compared to patients with higher SES. 59 , 273 , 369 , 380 Patients with lower SES have been considered by health care providers to be more “demanding,” 163 (p2094) and their pain has been referred to in “dehumanizing” ways. 378 (p152) Tamayo-Sarver and colleagues 79 wrote that SES was associated with “physicians’ perceptions of patients’ abilities, personalities, behaviors, and role demands” and that physicians “may treat patients preferentially if there is less social distance between them.” (p1245) Green and colleagues 15 suggested that more research is needed to better understand the factors that “systematically influence” physicians’ decisions regarding pain management.…”

What does person‐centred care mean, if you weren't considered a person anyway: An engagement with person‐centred care and Black, queer, feminist, and posthuman approaches

“…Diniz et al (2020) looked at how nurses conceptualize patients of different socioeconomic status (SES) and found that while patients with middle SES were depicted mostly with positive (autonomous and communicative), patients with low‐SES were also imagined with dehumanizing traits such as “passive towards pain, with poor future prospects and referred to psychoeducation” (Diniz et al, 2020, p. 152). Brandão et al (2019) found differences in how nurses perceived utterances of pain by patients with different SES. “The low‐SES patient's pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher‐SES patient's pain” (Brandão et al., 2019, p. 2094).…”

“…Brandão et al (2019) found differences in how nurses perceived utterances of pain by patients with different SES. “The low‐SES patient's pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher‐SES patient's pain” (Brandão et al., 2019, p. 2094). Diversity dimensions interact with one another in intersectionality.…”