Understanding the Provider Contribution to Race/Ethnicity Disparities in Pain Treatment: Insights from Dual Process Models of Stereotyping

Authors

  • Diana J. Burgess PhD,

    Corresponding author
    1. Department of Medicine, University of Minnesota;
    2. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota;
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  • Michelle Van Ryn PhD, MPH,

    1. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota;
    2. Department of Family Medicine and Community Health and Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota;
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  • Megan Crowley-Matoka PhD,

    1. University of Pittsburgh and Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pennsylvania;
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  • Jennifer Malat PhD

    1. Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
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Diana J. Burgess, PhD, Center for Chronic Disease Outcomes Research, VA Medical Center (1110), One Veterans Drive, Minneapolis, MN 55417, USA. Tel: 1-612-467-4673; Fax: 1-612-725-2118; E-mail: diana.burgess@med.va.gov.

ABSTRACT

Objective.  This article applied dual process models of stereotyping to illustrate how various psychological mechanisms may lead to unintentional provider bias in decisions about pain treatment. Stereotypes have been shown to influence judgments and behaviors by two distinct cognitive processes, automatic stereotyping and goal-modified stereotyping, which differ both in level of individual conscious control and how much they are influenced by the goals in an interaction. Although these two processes may occur simultaneously and are difficult to disentangle, the conceptual distinction is important because unintentional bias that results from goal-modified rather than automatic stereotyping requires different types of interventions.

We proposed a series of hypotheses that showed how these different processes may lead providers to contribute to disparities in pain treatment: 1) indirectly, by influencing the content and affective tone of the clinical encounter; and 2) directly, by influencing provider decision making. We also highlighted situations that may increase the likelihood that stereotype-based bias will occur and suggested directions for future research and interventions.

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