A randomized controlled trial testing a virtual perspective-taking intervention to reduce race and socioeconomic status disparities in pain care

Adam T. Hirsh, Megan M. Miller, Nicole A. Hollingshead, Tracy Anastas, Stephanie T. Carnell, Benjamin C. Lok, Chenghao Chu, Ying Zhang, Michael E. Robinson, Kurt Kroenke, Leslie Ashburn-Nardo

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

We conducted a randomized controlled trial of an individually tailored, virtual perspective-taking intervention to reduce race and socioeconomic status (SES) disparities in providers' pain treatment decisions. Physician residents and fellows (n = 436) were recruited from across the United States for this two-part online study. Providers first completed a bias assessment task in which they made treatment decisions for virtual patients with chronic pain who varied by race (black/white) and SES (low/high). Providers who demonstrated a treatment bias were randomized to the intervention or control group. The intervention consisted of personalized feedback about their bias, real-time dynamic interactions with virtual patients, and videos depicting how pain impacts the patients' lives. Treatment bias was re-assessed 1 week later. Compared with the control group, providers who received the tailored intervention had 85% lower odds of demonstrating a treatment bias against black patients and 76% lower odds of demonstrating a treatment bias against low SES patients at follow-up. Providers who received the intervention for racial bias also showed increased compassion for patients compared with providers in the control condition. Group differences did not emerge for provider comfort in treating patients. Results suggest an online intervention that is tailored to providers according to their individual treatment biases, delivers feedback about these biases, and provides opportunities for increased contact with black and low SES patients, can produce substantial changes in providers' treatment decisions, resulting in more equitable pain care. Future studies should examine how these effects translate to real-world patient care and the optimal timing/dose of the intervention.

Original languageEnglish (US)
Pages (from-to)2229-2240
Number of pages12
JournalPain
Volume160
Issue number10
DOIs
StatePublished - Oct 1 2019

Keywords

  • Disparities
  • Pain treatment
  • Perspective-taking
  • Virtual technology

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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  • Cite this

    Hirsh, A. T., Miller, M. M., Hollingshead, N. A., Anastas, T., Carnell, S. T., Lok, B. C., Chu, C., Zhang, Y., Robinson, M. E., Kroenke, K., & Ashburn-Nardo, L. (2019). A randomized controlled trial testing a virtual perspective-taking intervention to reduce race and socioeconomic status disparities in pain care. Pain, 160(10), 2229-2240. https://doi.org/10.1097/j.pain.0000000000001634