The roles of gender and profession on gender role expectations of pain in health care professionals

Journal of Pain Research Dovepress open access to scientific and medical research ORIGINAL RESEARCH Journal of Pain Research downloaded from https://www.dovepress.com/ by 54.37.117.73 on 12-Jul-2018 For personal use only. Open Access Full Text Article The roles of gender and profession on gender role expectations of pain in health care professionals This article was published in the following Dove Press journal: Journal of Pain Research Danielle M Wesolowicz Jaylyn F Clark Jeff Boissoneault Michael E Robinson Department of Clinical Health Psychology, University of Florida, Gainesville, FL, USA Introduction: Gender-related stereotypes of pain may account for some assessment and treatment disparities among patients. Among health care providers, demographic factors including gender and profession may influence the use of gender cues in pain management decision-making. The Gender Role Expectations of Pain Questionnaire was developed to assess gender-related stereotypic attributions of pain regarding sensitivity, endurance, and willingness to report pain, and has not yet been used in a sample of health care providers. The purpose of this study was to examine the presence of gender role expectation of pain among health care providers. It was hypothesized that health care providers of both genders would endorse gender stereotypic views of pain and physicians would be more likely than dentists to endorse these views. Methods: One-hundred and sixty-nine providers (89 dentists, 80 physicians; 40% women) were recruited as part of a larger study examining providers’ use of demographic cues in m aking pain management decisions. Participants completed the Gender Role Expectations of Pain Questionnaire to assess the participant’s views of gender differences in pain sensitivity, pain endurance, and willingness to report pain. Results: Results of repeated measures analysis of variance revealed that health care providers of both genders endorsed stereotypic views of pain regarding willingness to report pain (F(1,165)=34.241, P<0.001; d=0.479). Furthermore, female dentists rated men as having less endurance than women (F(1,165)=4.654, P=0.032; d=0.333). Conclusion: These findings affirm the presence of some gender-related stereotypic views among health care providers and suggest the presence of a view among health care providers that men are underreporting their pain in comparison to women. Future work can refine the effects of social learning history and other psychosocial factors that contribute to gender and provider differences in pain management decisions. Keywords: gender, pain, expectations, physicians, dentists Introduction Correspondence: Michael E Robinson Department of Clinical Health Psychology, University of Florida, 101 South Newell Drive, Room 3151, PO Box 100165, Gainesville, FL 32610-9165, USA Tel +1 352 273 5220 Fax +1 352 273 6156 Email 1121 submit your manuscript | www.dovepress.com Journal of Pain Research 2018:11 1121–1128 Dovepress © 2018 Wesolowicz et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/JPR.S162123 Powered by TCPDF (www.tcpdf.org) Gender-related expectations regarding a patient’s pain presentation (eg, chronicity, reported severity, and pain behaviors), demographics, and level of psychological distress can influence a health care provider’s decision-making.1 For instance, experimental studies have found that health care providers and trainees tend to view women as more likely to exaggerate their pain and less likely to minimize or hide it.2 These biases appear to affect treatment recommendations, as male patients are less likely to receive psychosocial assessment or treatment for pain3,4 and women patients are less likely to receive more aggressive analgesic treatment.5,6 Dovepress Journal of Pain Research downloaded from https://www.dovepress.com/ by 54.37.117.73 on 12-Jul-2018 For personal use only. Wesolowicz et al Equally important factors when examining gender differences in pain management are the characteristics of health care providers themselves. For example, male and female health care providers have been found to differ in their opioid-prescribing practices, the likelihood of recommending psychological interventions, and the use of patient distress as a clinical decision-making tool.7,8 Furthermore, health care providers are subject to gender role expectations regarding their clinical decision-making, with female health care providers generally expected to be more understanding and accepting of patient’s pain and its associated distress.8 Together, gender role expectations of the patient and health care provider may interact to influence pain management decisions. For example, studies have found that health care providers tend to provide more opioids to patients of the same gender.4,9,10 The study of the role of gender role expectations may provide valuable insight into mechanisms underlying pain management disparities. The Gender Role Expectations of Pain Questionnaire (GREP) is a standardized measure developed to assess gender-related stereotypic attributions of pain sensitivity, endurance, and willingness to report pain.11 Studies using the GREP in undergraduate samples have found that both men and women tend to affirm gender-related stereotypic attributions (ie, women are more willing to report pain, more sensitive to pain, and less able to endure pain than men).11,12 The GREP has not yet been used in a health care provider sample, and information from the GREP may provide valuable input into how gender-related stereotypic attributions in health care providers may contribute to pain assessment and treatment disparities. Although health care providers are trained with the goal of being “neutral providers” (ie, providing clinical care without regard to patient gender, race, ethnicity, and so on), they are subject to the same social influences that foster gender/ gender-related biases in the general population.13 Dentists and physicians see many patients with a primary complaint of pain, yet receive relatively little formal training in pain management and rely on simple cues for pain management decisions.14–17 Furthermore, because dentists and physicians differ in the types of pain conditions they typically treat, there may be cross-professional differences in how stereotypic cues are utilized when making pain decision (...truncated)