Classism in pain assessment and management: The mediating role of female patient dehumanizationand perceived life hardship

Abstract

Compared to racism and sexism, classism in pain assessment and management practices (PAMP) has been less investigated and its mediating mechanisms are still unknown. Drawing upon a social psychological model of dehumanization, this research aimed to test: (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMP and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (Low vs. High) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/pictures depicting two cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship and PAMP. The Low SES patient was perceived as less pain sensitive (medical students only) but more disabled, credible and her pain more attributed to psychological causes (by nurses only). Medical students recommended less non-pharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the Low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students only). Perceived life hardship mediated SES effects on pain disability, credibility (nurses only) and intentions of providing individualized care (nurses only). These finding bear novel contributions to the fields of pain, health service research and social psychology, and have important implications to the development of more effective future interventions to reduce classism in PAMP.