The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions

Abstract

Research suggests patient sex, provider sex, and providers' sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers' sexist attitudes were associated with these differences. Ninety-eight healthcare providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F(1,96)=4.51, p<.05, η_p²=.05) and mental health (MH) referral (F(1,96)=3.89, p=.05, η_p²=.04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers' sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than male pain patients, and providers' sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities.

PERSPECTIVE:

The results of this study suggest that patient and provider sex, but not providers' sexist attitudes, influence pain care. These findings may inform efforts to raise awareness of sex/gender differences in pain care and reduce disparities.

Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

decision making, pain treatment, sex differences, sexist attitudes, virtual technology

PMID:

 

24576430

 

[PubMed - as supplied by publisher]

The effect of patient involvement in surgical decision making for carpal tunnel release on patient-reported outcome

To investigate whether patient-reported outcomes are different according to patients' preference or experience in surgical decision making for carpal tunnel release.

METHODS:

We preoperatively surveyed 85 patients who underwent carpal tunnel release regarding their preferred role in the process of surgical decision making and assessed their experienced role in the actual decision making 6 months after surgery using a Control Preference Scale. For patient-reported surgical outcomes, we used the Disabilities of the Arm, Shoulder, and Hand questionnaire. We compared these outcomes with those of patients having different preferences or experiences in surgical decision making and also compared the outcomes according to whether the preferred roles match the experienced roles.

RESULTS:

The Disabilities of the Arm, Shoulder, and Hand scores were not significantly different between patients with different preferences for involvement in decision making for surgery or between those with different experiences in the actual decision making. However, those who experienced the same level of involvement as they had preferred were found to have better Disabilities of the Arm, Shoulder, and Hand scores than those who experienced a more active role or a more passive role than they had preferred.

CONCLUSIONS:

This study demonstrates that patient-reported outcomes were not different between those with different preferences or experiences in surgical decision making for carpal tunnel release. However, this study suggests that patients whose experience in decision making matched with their preference may have better subjective outcomes after carpal tunnelrelease. This suggests that patients with carpal tunnel syndrome may benefit from physicians' efforts of identifying patients' preferences for involvement in decision making and matching the identified preferences to the decision-making process.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Prognostic II.

Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Carpal tunnel syndrome, carpal tunnel release, decision making, involvement, outcomes