Perceived Discrimination in Health Care Is Associated With a Greater Burden of Pain in Sickle Cell Disease

Abstract

Context Perceived discriminatory experiences in society have been associated with a higher burden of pain among some minority patient populations. Objectives To describe the extent to which patients with sickle cell disease (SCD) perceive discrimination from health care providers, and to examine the association of these experiences with the burden of chronic SCD pain. Methods Cross-sectional analysis of data collected at baseline of a prospective cohort study of SCD patient experiences of care (n = 291). Perceived race-based and disease-based discrimination from health care providers were measured using subscales adapted from the Interpersonal Processes of Care Survey. Discrimination scores were examined for their association with patient characteristics and measures of pain burden using descriptive, bivariate, and multivariate analytic techniques. Results Respondents reported a greater burden of race-based discrimination from health care providers than has been previously reported by African Americans, and they reported a greater amount of disease-based versus race-based discrimination. While age and having difficulty persuading providers about pain were the only patient characteristics independently associated with race-based discrimination, older age, greater emergency room utilization, having difficulty persuading providers about pain, daily chronic pain, fewer “good days” during a week, and a higher severity of pain on their “good days” were independently associated with greater disease-based discrimination. Conclusion Perceived disease-based, but not race-based, discrimination was found to be associated with a greater range of self-reported pain among patients with SCD. If causal, this finding could signal an important new approach to mitigating the burden of pain experienced by persons with SCD.

Acute Pain and Depressive Symptoms: Independent Predictors of Insomnia Symptoms among Adults with Sickle Cell Disease

“…This item has been used in several studies of SCD by the IMPORT research team. In a prior study, the IMPORT team demonstrated that this item performed as well as “the number of good days [the participant] experienced each week” (higher score equals a lower burden of pain during the week) and “self-reported pain on a good day” (higher score equals more severe pain on a good day) (Haywood et al, 2014), which are other items used to measure the burden of chronic pain in adults with SCD. Therefore, we selected this item as a valid measure of chronic SCD pain for the current study.…”

Dimensions of Racial Identity and Perceived Discrimination in Health Care

“…[29][30][31] They have lower satisfaction with care, 32,33 higher levels of medical mistrust, 32 and are less likely to adhere to physicians' recommendations. 34 Thus, perceived discrimination in health care predicts a host of adverse outcomes, from poor self-reported health to obesity, diabetes, hypertension, heart disease, birth outcomes, and mental health problems. [16][17][18][19][35][36][37][38][39][40][41][42] Previous research suggests that racial discrimination may be a critical mechanism linking the aspects of racial/ethnic identity to health outcomes.…”

Palliative Care Teams as Advocates for Adults with Sickle Cell Disease

“…30 (2) Patients with SCD report experiencing discriminatory behavior from health care providers. 31 (3) Higher levels of implicit bias among clinicians have been directly linked with inequities in treatment recommendations for African Americans and have been associated with poor quality of patientphysician communication. 23 (4) As a result, there can be a vicious cycle, as true or perceived discrimination from health care providers is associated with greater nonadherence to management regimens, 25 which is especially problematic for the nearly 30% of adults with SCD who report chronic pain.…”