Risk Management Tools & Resources


10 Strategies Healthcare Organizations Can Employ to Address Bias in Pain Management

Laura M. Cascella, MA

10 Strategies Healthcare Organizations Can Employ to Address Bias in Pain Management

Bias in pain management is an ongoing and complex issue in healthcare. Research has shown disparities in pain management in relation to race, ethnicity, gender, and socioeconomic status. Complicating matters, many instances of bias are implicit, creating a need not only to address the bias, but also to raise awareness of its existence.

Recognizing and addressing bias are imperative. Failure to treat pain or poorly treated pain can interfere with how patients recover from illnesses and procedures, which can potentially cascade into numerous patient safety and financial consequences, such as increased morbidity, hospitalizations and readmissions, and liability exposure. Additionally, bias in pain treatment may lead to misdiagnosis, unnecessary patient suffering, lack of patient trust in healthcare providers, communication lapses, and failure to provide patient-centered care.1

Researchers have studied and proposed a variety of techniques to reduce bias in pain management, and many healthcare organizations are taking steps to acknowledge and address this issue. Some strategies that have been recommended at the institutional level include:

  1. Administering the Implicit Association Test (IAT) to assess subconscious feelings, attitudes, and thoughts among providers that may contribute to stereotypes and bias in treatment decisions
  2. Surveying providers and staff to better understand how they perceive the organization’s policies and actions related to improving diversity and addressing discrimination
  3. Developing a protocol to investigate reports of discrimination or unfair policies/practices
  4. Supporting provider and staff training that raises awareness about bias in healthcare and teaches strategies that support health equality
  5. Leveraging data capabilities to monitor and compare patient treatment and outcomes by race, gender, and socioeconomic indicators
  6. Providing constructive feedback and innovative solutions at various levels (e.g., by department, care unit, staff role, or individual) to address issues of bias
  7. Establishing accountability and expectations relative to implementing techniques to reduce bias and improve quality of care
  8. Devising strategies to address the burden of high cognitive workload, which may result in providers defaulting to automatic reasoning and decision-making processes that are vulnerable to bias
  9. Promoting diversity, empathy, and understanding throughout the organization via methods such as intergroup and equal-status contact, team building, positive association, and counter-stereotype exposure
  10. Encouraging providers and staff to engage in individual efforts to address bias through ongoing education about debiasing techniques and cultural awareness2

These strategies show promise in confronting the pervasive issue of bias in pain management, but more research is needed to identify new solutions, determine best practices, and evaluate the feasibility of introducing various techniques into clinical practice. For more information on this topic, read the full article titled Lurking Beneath the Surface: Bias in Pain Management.

1 Keller, A. (2016, August 24). What every nurse needs to know about pain management. Daily Nurse. Retrieved from http://dailynurse.com/what-every-nurse-needs-to-know-about-pain-management/; The Joint Commission. (2016, April). Implicit bias in healthcare. Quick Safety. Retrieved from www.jointcommission.org/assets/1/23/Quick_Safety_Issue_23_Apr_2016.pdf

2 The Joint Commission, Implicit bias in healthcare; Drwecki, B. B. (2015, March). Education to identify and combat racial bias in pain treatment. AMA Journal of Ethics, 17(3), 221–228; Tropp, L. R., & Godsil, R. D. (2015, January 23). Overcoming implicit bias and racial anxiety. Psychology Today. Retrieved from www.psychologytoday.com/blog/sound-science-sound-policy/201501/overcoming-implicit-bias-and-racial-anxiety; Croskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 2: Impediments to and strategies for change. BMJ Quality & Safety, 22(Suppl 2), ii65–72; Bernhofer, E. (2011, October 25). Ethics and pain management in hospitalized patients. The Online Journal of Issues in Nursing, 17(1). Retrieved from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-17-2012/No1-Jan-2012/Ethics-and-Pain-Management.html

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