Factors that Influence Providers’ Pain Treatment Decisions

poster abstractMedical and non-medical factors influence providers’ pain treatment decisions. Among these, patient demographic characteristics and substance use have received particular attention. However, few empirical studies have examined the specific factors providers rely on for their pain treatment decisions. This study employed lens model methodology to examine the factors that providers reportedly used, actually used, and would have used (if available) to make pain treatment decisions. We hypothesized that: (1) providers would rate patients’ pain history and description of pain as the most influential factors provided in the clinical vignettes, and (2) providers would rate patients’ substance use history as the most important factor not provided in the vignettes. 100 providers viewed 16 computer-simulated patients; each included a picture with accompanying text describing the patient’s medical condition. After making multi-modal treatment ratings for each patient, providers indicated the factors they used to make treatment decisions and the factors they would have used (if available) to make decisions. Results indicated that most providers reported being influenced by patients’ pain histories (98%) and descriptions (96%), whereas fewer reported using patients' movement (75%) or demographic characteristics (62%). Providers reported that they wanted additional information on patients’ treatment histories (98%), current/average pain (96%), and drug use (94%) to guide their decisions. Exploratory analyses indicated that, compared to providers who were not statistically influenced by patient demographics, a slightly greater proportion of providers who were statistically influenced by patient demographics wanted additional information about patients’ alcohol use to inform their decisions, χ2 (1) = 3.09, p = .08. These results suggest that providers prioritize both objective and subjective information about patients’ pain conditions, as well as patients’ substance use behaviors, when making treatment decisions. These findings have important implications for pain management and may lead to improved patient safety and care

Examining Gender Differences in Pain Treatment Recommendations

poster abstractUnderstanding how pain treatment decisions are made has important clinical implications for healthcare. Research suggests that men and women receive disparate pain care, however, little is known about the specific treatment recommendations that are differentially made for men and women. The purpose of this study was to examine differences between the types of pain treatments recommended for men and women. Undergraduate psychology students from Indiana University-Purdue University Indianapolis (IUPUI) and the University of North Texas (UNT) (n=621) made treatment recommendations for 8 chronic pain patients after reading a vignette describing the patient’s pain and watching a video of each patient completing a pain-inducing task (i.e., transition between sitting and standing). Participants made pain treatment recommendations for each patient using separate 0-100 visual analogue scales (VASs). Dependent samples t-tests indicated that participants were more likely to recommend workplace accommodations (t(620)= -3.05, p= .002, d= 0.17), disability compensation (t(620)= -7.77, p< .001, d= 0.44), and opioid medications (t(620)= -5.16, p< .001, d= 0.29) for men compared to women. Moreover, participants were more likely to recommend psychological therapy (t(620)= 4.59, p< .001, d= 0.26), rest (t(620)= 7.80, p< .001, d= 0.44), and diet/exercise (t(620)= 2.97, p= .003, d= 0.17) for women compared to men. These results are consistent with social psychological theories of gender-based stereotyping and suggest that men’s pain was perceived to be more legitimate, severe, and disabling than was women’s pain. Future studies are needed to examine how these differences affect pain outcomes and whether knowledge of these factors can improve training for future health care providers

Examining Influential Factors in Providers’ Chronic Pain Treatment Decisions: A Comparison of Physicians and Medical Students

Reports have found that chronic pain management guidelines are unclear and conflicting. Due to this confusion, it is critical to understand factors that influence providers’ treatment decisions for chronic pain. Little is known about which factors providers use to make treatment decisions or whether providers of different training levels endorse using similar factors. The purpose of this study was to examine the factors that providers report using to make their chronic pain treatment decisions. We hypothesized that providers would: (1) prioritize objective factors over subjective factors, (2) be particularly interested in information about patients’ substance use, and (3) endorse using different factors depending on their training level (physicians vs. medical students). Eighty-five providers (35 medical students, 50 physicians) viewed 16 computer-simulated patients; each included a picture with text describing the patients’ condition (i.e., chronic lower back pain, open to any treatment, presence/absence of depression). After making treatment decisions, participants selected from a list the factors they used and would have used (if the information had been available) to make their treatment decisions. Most providers reported being influenced by patients’ pain histories (97.6%) and pain descriptions (95.3%). Providers indicated they would have used information about patients’ previous treatments (97.6%), average pain ratings (96.5%), and current pain (96.5%) had this information been available. Compared to physicians, medical students endorsed more often that they would have used patients’ employment and/or disability status (p<.01), illicit drug use (p=.09), and alcohol use (p=.08) to make treatment decisions. These results indicate that providers rely on objective and subjective information to make pain treatment decisions, and compared to physicians, medical students place a stronger emphasis on patients’ substance abuse and social history when making treatment decisions. Future studies should examine additional provider and patient factors that influence decisions for specific pain treatment options