Experiences of racial discrimination in the medical setting and associations with medical mistrust and expectations of care among black patients seeking addiction treatment

Hall, O.; Jordan, Ayana; Teater, Julie; Dixon-Shambley, Kamilah; McKiever, Monique; Baek, Mikyung; Garcia, Stephanie; Rood, Kara M.; Fielin, David A.

doi:10.1016/j.jsat.2021.108551

Cited by 52 publications

(30 citation statements)

References 49 publications

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“…Importantly, patient-provider interactions and the social context surrounding treatment are unlikely to be the same for all patients. For instance, experienced discrimination is associated with increased stress and reduced physical and mental health [60], and individuals who have experienced negative outcomes or discrimination in a healthcare environment have different expectations than individuals who have had positive experiences [61] (also Box 2).…”

Section: Social Influences On Placebo Analgesiamentioning

confidence: 99%

A social affective neuroscience lens on placebo analgesia

Atlas

2021

Trends in Cognitive Sciences

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Pain is a fundamental experience that promotes survival. In humans, pain stands at the intersection of multiple health crises: chronic pain, the opioid epidemic, and health disparities. The study of placebo analgesia highlights how social, cognitive, and affective processes can directly shape pain, and identifies potential paths for mitigating these crises. This review examines recent progress in the study of placebo analgesia through affective science. It focuses on how placebo effects are shaped by expectations, affect, and the social context surrounding treatment, and discusses neurobiological mechanisms of placebo, highlighting unanswered questions and implications for health. Collaborations between clinicians and social and affective scientists can address outstanding questions and leverage placebo to reduce pain and improve human health.Pain: a biopsychosocial phenomenon that requires integrative research Pain (see Glossary) lies at the core of multiple health crises. It is central to the opioid epidemic [1,2], there are substantial health disparities in pain [3][4][5], over 11% of American adults report experiencing daily pain [6], and chronic pain is highly comorbid with other central nervous system conditions, including mental health illnesses [7] and substance use disorders [8]. Healthcare practitioners have reduced opioid prescriptions in response to the opioid epidemic [9], but we lack effective alternatives, including nonaddictive and nonpharmacological therapies.Hope can be found in the progress the field has made in isolating the mechanisms that contribute to pain through animal models because the systems that process pain [10] and nociception are highly conserved across species. Nevertheless, pain in humans is ultimately a subjective, conscious experience that involves the integration of sensory processing, emotion, context, and decision making. Understanding human pain requires an integrative approach that draws on psychology, neuroscience, and medicine. In this review I focus on placebo analgesia, a phenomenon that lies at the intersection of these diverse fields. In the following sections I review the critical influences of expectations, affect, and the social context surrounding treatment (Figure 1, Key figure). I then discuss the brain mechanisms underlying placebo effects and the extent to which placebo analgesia provides insights into domains other than pain. Throughout, I emphasize that research on the placebo effect has important implications for the urgent crises surrounding opioid use disorder and health disparities in pain. HighlightsThe study of placebo analgesia provides insights into how pain and clinical outcomes are shaped by social, cognitive, and affective processes.

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Section: Social Influences On Placebo Analgesiamentioning

confidence: 99%

A social affective neuroscience lens on placebo analgesia

Atlas

2021

Trends in Cognitive Sciences

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“…These scales measure everyday discrimination but not discrimination specifically in medical settings. To the authors' knowledge, only a handful of studies have examined the impact of discrimination specifically in medical settings [11,[20][21][22]. These studies used the Discrimination in Medical Settings (DMS) scale, which measures healthcare provider-based discrimination that has been validated for use in Black Americans [20].…”

Section: Introductionmentioning

confidence: 99%

“We’re Not Taken Seriously”: Describing the Experiences of Perceived Discrimination in Medical Settings for Black Women

Washington

Randall

2022

J. Racial and Ethnic Health Disparities

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Objectives Cervical cancer disparities persist for Black women despite targeted efforts. Reasons for this vary; one potential factor affecting screening and prevention is perceived discrimination in medical settings. The purpose of this study was to describe experiences of perceived discrimination in medical settings for Black women and to explore the impact on cervical cancer screening and prevention. Methods This paper presents mixed methods results using the Discrimination in Medical Settings (DMS) scale and qualitative interviews to understand the medical experiences of Black women. We administered the DMS scale to 48 Black women and interviewed five about their experiences engaging in the healthcare system. Results High levels of perceived discrimination were experienced by our sample, with the majority of women having experienced discrimination in the medical setting. Qualitative data contextualized these results, including the impact on the patient-provider relationship and on the development of medical mistrust. Most women reported they had been screened within the last 3 years (75%) and had seen a doctor within the past year (89.6%). Conclusions Black women are engaging in healthcare while experiencing perceived discrimination in medical settings. Future interventions should address the poor quality of medical encounters that Black women experience.

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“…Consequentially, medical mistrust and concerns about privacy, stigmatization, and discrimination based on genetic test results are commonly found [ 30 ]. Other studies have also found that past negative healthcare experiences and expectations of experiencing racism in healthcare settings were strong predictors of greater medical mistrust and healthcare avoidance [ 40 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

Hoadley

Bass

Chertock

et al. 2022

IJERPH

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Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient–oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust.

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Experiences of racial discrimination in the medical setting and associations with medical mistrust and expectations of care among black patients seeking addiction treatment

Cited by 52 publications

References 49 publications

A social affective neuroscience lens on placebo analgesia

A social affective neuroscience lens on placebo analgesia

“We’re Not Taken Seriously”: Describing the Experiences of Perceived Discrimination in Medical Settings for Black Women

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

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