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Clinical Trial
. 2016 Apr 19;113(16):4296-301.
doi: 10.1073/pnas.1516047113. Epub 2016 Apr 4.

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

Kelly M Hoffman  1 , Sophie Trawalter  2 , Jordan R Axt  2 , M Norman Oliver  3
Affiliations
Clinical Trial

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

Kelly M Hoffman et al. Proc Natl Acad Sci U S A. .

Abstract

Black Americans are systematically undertreated for pain relative to white Americans. We examine whether this racial bias is related to false beliefs about biological differences between blacks and whites (e.g., "black people's skin is thicker than white people's skin"). Study 1 documented these beliefs among white laypersons and revealed that participants who more strongly endorsed false beliefs about biological differences reported lower pain ratings for a black (vs. white) target. Study 2 extended these findings to the medical context and found that half of a sample of white medical students and residents endorsed these beliefs. Moreover, participants who endorsed these beliefs rated the black (vs. white) patient's pain as lower and made less accurate treatment recommendations. Participants who did not endorse these beliefs rated the black (vs. white) patient's pain as higher, but showed no bias in treatment recommendations. These findings suggest that individuals with at least some medical training hold and may use false beliefs about biological differences between blacks and whites to inform medical judgments, which may contribute to racial disparities in pain assessment and treatment.

Keywords: health care disparities; pain perception; pain treatment; racial bias.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Nonmedical sample estimated mean pain ratings for black and white targets as a function of false belief endorsement (scale: 1–6; plotted 1 SD below and above the mean). Pain rating scale: 1 = not painful, 2 = somewhat painful, 3 = moderately painful, 4 = extremely painful.
Fig. 2.
Fig. 2.
Medical sample estimated mean pain ratings and treatment recommendation accuracy as a function of false belief endorsement (plotted 1 SD below and above the mean). (A) Average pain ratings (pain rating scale: 0 = no pain; 1; 2 = mild pain; 3; 4 = moderate pain; 5; 6 = severe pain; 7; 8 = very severe pain; 9; 10 = worst possible pain). (B) Proportion of participants recommending accurate treatment for black and white target patients (treatment recommendation accuracy scale: 1 = accurate, 0 = inaccurate).
See this image and copyright information in PMC

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