March 1, 2024

The Impact of Patient Race, Patient Socioeconomic Status, and Cognitive Load of Physician Residents and Fellows on Chronic Pain Care Decisions

Kurt Kroenke, MD

Published in the Journal of Pain. Here is a link to the article. 

Regenstrief Institute authors:  Kurt Kroenke, PhD 


Social stereotypes are more likely to influence decision-making under conditions of high cognitive load (i.e., mental workload), such as in medical settings. We examined how patient race, patient socioeconomic status (SES), physician cognitive load, and physician implicit beliefs about race and SES differences in pain tolerance impacted physicians’ pain treatment decisions. Physician residents and fellows (N = 120) made treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the physicians were randomized to be interrupted during the decision task to make hypertension medication conversion calculations (high cognitive load group), while the other half completed the task without interruptions (low cognitive load group). Both groups were given equal time to make pain care decisions (2.5 minutes/patient). Results of multilevel ordinal logistic regression analyses indicated that physicians prescribed weaker analgesics to patients with high vs. low SES (odds ratio = .68, 95% confidence interval [.48, .97], P = .03). There was also a patient SES-by-cognitive load interaction (odds ratio = .56, 95% confidence interval [.31, 1.01], P = .05) that is theoretically and potentially practically meaningful but was not statistically significant at P < .05. These findings shed light on physician cognitive load as a clinically-relevant factor in the context of pain care quality and equity.

These findings highlight the clinical relevance of physician cognitive load (e.g., mental workload) when providing pain care for diverse patients. This line of work can support the development of interventions to manage physician cognitive load and its impact on pain care, which may ultimately help reduce pain disparities.

Tracy Anastas 1Wei Wu 2Diana J Burgess 3Jesse C. Stewart 2Michelle P. Salyers 2Kurt Kroenke 4Adam T. Hirsh 2

1Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; Department of Family Medicine, University of Washington, Seattle, Washington.

2Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana.

3Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.

4Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc., Indianapolis, Indiana.

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