Dismantling barriers in pain management through an intersectional multi-method examination of race and gender biases

PROJECT SUMMARY The proposed Mentored Research Scientist Development Award (K01) will launch Dr. Mollie Ruben's program of research as an independent scientist focusing on identifying and reducing race and gender biases in pain care. This goal will be achieved through a 5-year parallel research and tailored training plan.

Training goals include building expertise in (1) racial disparities and intersectionality in healthcare; (2) clinical pain research, translational studies, and implementation science; (3) multiple mediation and programming in R; and (4) leadership and professional skills to execute team-based science. Training goals will be met

through a comprehensive training plan with Drs. Stein (expert in racial disparities), Batchelder (expert in gender minorities/stigma), and Elwy (expert in clinical pain research/implementation science), along with consultants with expertise in mediation (Nguyen), simulation research (Blum), medical education (Warrier,

Rougas), and implicit bias (Maddox); workshops; conferences; coursework; and experiential activities. Skills gained through the training plan will be put into action through a complementary research plan aimed to identify mechanisms underlying race and gender pain care disparities among medical students. The

management of pain is marked by inequities, particularly in the underestimation, inaccurate recognition, and mistreatment of pain in women and people of color. Despite these challenges, there is a lack of research on pain assessment biases, including race, gender, and transgender and gender-diverse (TGD) patients. This

proposal addresses these gaps by developing pain assessment methods inclusive of TGD people (N = 80) and examining medical students' (N = 120) implicit and explicit biases in pain assessment and their impact on pain care disparities during a standardized patient (SP) interaction. The proposed project has three

specific aims: (1) analyze new racially diverse TGD pain videos and test for differences in the experience of pain; (2) establish the pattern of relationships between medical students' implicit and explicit race and gender biases on perceptual biases in pain assessment; (3) determine the extent to which pain assessment

biases are a mechanism underlying disparities in pain treatment and care. Findings from the proposal will provide preliminary data for a R01 application to be completed by Dr. Ruben during the award period. The proposed research seeks to address knowledge gaps by identifying underlying mechanisms responsible for

intersectional race and gender disparities, with the goal to implement effective evidence-based provider- level interventions to mitigate biases and promote more equitable pain care for systematically marginalized patients. Thus, this proposal is in line with NIMHD Minority Health and Health Disparities Research

Framework and NIMHD's Strategic Plan to investigate patient–clinician communication affecting health disparities emphasizing the sociocultural environment, healthcare system, and provider levels of influence. Completion of the K01 will provide Dr. Ruben with the expertise to conduct innovative, high-impact research.