Reducing racial disparities in pain treatment: The role of empathy and perspective-taking

Abstract

Epidemiological evidence indicates that African Americans receive lower quality pain treatment than European Americans. However, the factors causing these disparities remain unidentified, and solutions to this problem remain elusive. Across three laboratory experiments, we examined the hypotheses that empathy is not only causing pain treatment disparities but that empathy-inducing interventions can reduce these disparities. Undergraduates (Experiments 1 and 2) and nursing professionals (Experiment 3) watched videos of real Black and White patients' genuine facial expressions of pain, provided pain treatment decisions, and reported their feelings of empathy for each patient. The efficacy of an empathy-inducing, perspective-taking intervention at reducing pain treatment disparities was also examined (Experiments 2 and 3). When instructed to attempt to provide patients with the best care, participants exhibited significant pro-White pain treatment biases. However, participants engaged in an empathy-inducing, perspective-taking intervention that instructed them to imagine how patients' pain affected patients' lives exhibited upwards of a 55% reduction in pain treatment bias in comparison to controls. Furthermore, Pro-White empathy biases were highly predictive of pro-White pain treatment biases. The magnitude of the empathy bias experienced predicted the magnitude of the treatment bias exhibited. These findings suggest that empathy plays a crucial role in racial pain treatment disparities in that it appears not only to be one likely cause of pain treatment disparities but also is an important means for reducing racial disparities in pain treatment.

Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities

“…Nurses told to use their best judgment recommended significantly more pain medication for White than Black patients, whereas nurses instructed to imagine how the patient felt recommended equal analgesic treatment regardless of race. 61 It may thus be possible to reduce disparities in pain treatment if providers actively attempt to take patients' perspectives. In addition to behavioral strategies aimed at individual physicians, the contribution of implicit race bias to health care disparities could be reduced on a population level by increasing the number of African American/Black physicians because they consistently demonstrate less race bias.…”

Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods

“…Arguably, emotional barriers to behaviour change are under-addressed in the work of Michie and colleagues (2005). A good example of targeting emotion to change behavior is that of a successful intervention to boost empathy for ethnic minority patients in pain, thereby improving assessment of their pain, where education on pain had failed to overcome discounting of pain based on racial stereotyping (Drwecki, Moore, Ward & Prkachin, 2011). significant increase in nursing assessment of pain at rest and movement (% not specified) no change in use of nonpharmacological methods…”

A Less Attractive Feature of Empathy: Intergroup Empathy Bias

“…For example, Drwecki et al [66] found that White participants reported greater empathic concern for White individuals in pain than for Black individuals in pain, and ofered higher levels of analgesic treatment for ingroup compared to outgroup members. Also, in two neuroimaging studies, empathy-related neural activity when observing ingroup members' sufering relative to outgroup members' sufering predicted greater willingness to donate time and money [63], as well as greater costly helping [18] for ingroup members at a later stage.…”