Patient and Provider Attitudes, Beliefs, and Biases That Contribute to a Marginalized Process of Care and Outcomes in Chronic Musculoskeletal Pain: A Systematic Review—Part I: Clinical Care
Autor: | Gabrielle M. Harris, Corey M. Huff, Alicia J. Emerson, Lauren E. Chandler, Riley H. Oxendine, G. David Baxter, Elizabeth C. Wonsetler Jones |
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Rok vydání: | 2021 |
Předmět: |
Adult
medicine.medical_specialty Vulnerable adult media_common.quotation_subject Scopus CINAHL 03 medical and health sciences 0302 clinical medicine Bias Musculoskeletal Pain Multidisciplinary approach Health care Cytidine Monophosphate medicine Humans Conversation 030212 general & internal medicine Retrospective Studies media_common business.industry Chronic pain Retrospective cohort study General Medicine medicine.disease Anesthesiology and Pain Medicine Attitude Family medicine Female Neurology (clinical) Chronic Pain business 030217 neurology & neurosurgery |
Zdroj: | Pain Medicine. 23:655-668 |
ISSN: | 1526-4637 1526-2375 |
DOI: | 10.1093/pm/pnab195 |
Popis: | Objective Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables, including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important. Design The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and health care providers (HCPs) involved in the clinical conversation about CMP, and 2) examine whether and how these perceptions impacted the process of care. Methods A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Included studies were those investigating vulnerable adult populations with chronic pain. Study bias was examined with the Downs and Black tool. Results Seven retrospective studies were included. When making pharmaceutical management decisions, HCPs demonstrated negative implicit biases toward minorities and women. When making referrals to multidisciplinary care, HCPs demonstrated negative implicit biases toward women with lower educational attainment. Unmet patient expectations resulted in higher dropout rates at multidisciplinary pain management programs. Patients’ trust was influenced by the health care setting, and patients often had limited options secondary to health insurance type/status. Conclusion These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs’ negative implicit biases, unmet patient expectations, and the health care setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited health care choices. |
Databáze: | OpenAIRE |
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