An experimental investigation of the causes of and solutions to racial pain treatment bias

Research documenting racial disparities in pain treatment where African American patients receive lower quality pain treatment is common (for a review see Green et al., 2003). Yet, the causes of these disparities remain unidentified, and solutions to this problem remain elusive. Four laboratory experiments were designed to test hypotheses as to the causes and solutions of racial pain treatment bias. Undergraduates (Experiments 1, 2, and 3) and Registered Nurses (RNs; Experiment 4) examined short videos of real Black and White patients expressing genuine facial expressions of pain while either attempting to make their "best treatment decisions" for each patient or while engaged in a perspective-taking intervention which instructed participants to imagine how their patient "feels about his or her pain and how this pain is affecting his or her life." Participants then provided pain treatment decisions, reported feelings of empathy, perceptions of patient pain, perceptions of patient SES, perceptions of patient malingering, and completed measures assessing stereotypes and prejudice. A consistent pro-White pain treatment bias was observed for participants attempting to make their best treatment decisions. However, participants engaged in the empathy-inducing, perspective-taking intervention exhibited upwards of a 55% reduction in pain treatment bias. Results suggest that racial empathy biases are driving racial biases in pain treatment. However, neither perceptions' of patient pain, perceptions of patient malingering, perceptions of patient SES, measures of implicit and explicit stereotyping, nor measures of implicit and explicit prejudice accounted for these group-level racial pain treatment biases. Empathy appears not only to be one likely cause of pain treatment disparities but also an important means for reducing racial disparities in pain treatment. Research is still needed to determine whether empathy-inducing interventions will be effective at reducing racial pain treatment bias in clinical settings.