Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses' Pain Assessment and Management Practices

Tânia Brandão, Lúcia Campos, Lies de Ruddere, Liesbet Goubert, Sónia F Bernardes
Pain Medicine: the Official Journal of the American Academy of Pain Medicine 2019 November 1, 20 (11): 2094-2105

OBJECTIVE: Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses' pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices.

DESIGN: Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design.

SUBJECTS: Female nurses participated in two experimental studies (N = 150/N = 158).

METHODS: Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices.

RESULTS: The low-SES patient's pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient's pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices.

CONCLUSIONS: Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

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