Systematic review of clinical decision-makers’ attitudes, beliefs, and biases that contribute to a marginalized process of care in persistent musculoskeletal pain. Part II: case vignettes

Abstract

Abstract Background Healthcare clinical decision makers’ (CDMs) attitudes, beliefs, and biases can negatively contribute to both clinical conversations and subsequent inequitable management decisions in persistent musculoskeletal pain (PMP). Understanding the factors that may contribute to CDMs’ decisions is particularly important for vulnerable patient populations. Objectives The aim of this systematic review was to synthesize the current research investigating the impact of CDM’s attitudes, beliefs, and biases on the process of care in PMP management in adults. Methods A systematic search following PRISMA guidelines was run in five databases: CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science. Included studies: vulnerable adult populations with chronic pain. Methodological quality was assessed with the Downs and Black tool. Results Nine studies were included. Studies examined CDMs’ perceptions of case vignettes used in medical schools, allied health professional programs, and in healthcare settings. Implicit biases related to pain severity and favoring medical evidence influenced CDMs’ perceptions of case legitimacy. Pharmaceutical management decisions were influenced by race/ethnicity, gender, pain severity, medical evidence, and non-verbal patient behavior. Pain severity influenced non-pharmaceutical management decisions. Conclusion Implicit biases related to race/ethnicity, gender, supporting medical evidence, and pain severity were demonstrated in educational settings and persisted in clinical settings. Health professional curricula should include training with a focus on outcomes that demonstrate increased awareness of the factors that could lead to inequitable management decisions. Addressing biases during the training of CDMs will be necessary to improve congruency of clinical conversations and minimize marginalization of patient care in PMP.