Documenting Race and Gender Biases in Pain Assessment and a Novel Intervention Designed to Reduce Biases.

Disparities in pain care are well-documented such that women and people of color have their pain undertreated and underestimated compared to men and White people. One of the contributors of the undertreatment of pain for people of color and women may be the inaccurate assessment of pain. Understanding the pain assessment process is an important step in evaluating the magnitude of and intervening on pain disparities in care. In the current work, we focus on documenting intersectional race and gender biases in pain assessment and present the results of a novel intervention for reducing these biases. Across 3 studies (N = 532) and a mini meta-analysis using real videotaped people in pain as stimuli, we demonstrate that observers disproportionately underestimated women of color's pain compared to all other groups (men of color, White women, and White men). In study 3 (N = 232), we show that a novel intervention focused on behavioral skill building (ie, practice and immediate feedback) significantly reduced observers' pain assessment biases toward marginalized groups compared to all other types of trainings (raising awareness of societal biases, raising awareness of self-biases, and a control condition). While it is an open question as to how long this type of intervention lasts, behavioral skills building around assessing marginalized people's pain more accurately is a promising training tool for health care professionals. PERSPECTIVE: This article demonstrates the underestimation of pain among people of color and women. We also found support that a novel intervention reduced observers' pain assessment biases toward marginalized groups. This could be used in medical education or clinical care to reduce intersectional pain care disparities.

The Effect of Singular Nonverbal Behaviours of Experimenters on Pain Reports.

Introduction: Studies suggest facial expressions of caregivers may be important in placebo effects; however, this has not been systematically tested. This experiment investigated the effects of caregivers' singular positive nonverbal behaviours (NBs) on pain reports. Methods: Fifty-one males and 53 females (total of 104) participants were randomized to four groups that were displayed positive facial expressions, tone of voice, body movement, or neutral NBs of videotaped experimenters. Subjective reports of pain, stress, arousal, and cardiac activity were obtained in a pre-test, a conditioning phase, and at a post-test. Four minutes of heat pain was induced in each test, and a placebo cream was administered before the conditioning and post-test in all groups. Results: There were no differences between the NB groups in the reduced pain. Males had larger reduction in pain in the post-test, and females had lower arousal than the opposite sex. During the conditioning, females had larger reduction in pain ie, unconditioned pain response (UPR). In females, the UPR predicted the reinforced expectation ie, increase in expectations from conditioning to post-test, and fear of minor pain negatively predicted both the UPR and reinforced expectation. Discussion: Singular NBs of caregiver were weak to enhance placebo effects. Females had lower pain during conditioning, and the UPR amplitude in females was associated with positive expectations. Moreover, for females, fear of minor pain weakened the UPR and expectations of cream. Conclusion: No NB of caregivers is more effective in reducing pain. Caregivers' NBs are less effective when displayed individually. Males and females may be different in underlying mechanisms of placebo effects.

Preserving privacy in the era of openness: Commentary on open science requirements for identifiable data in psychological science journals.

Psychological science journals are increasingly adopting open science (OS) policies (e.g., Transparency and Openness Promotion) requiring researchers to make all data and materials publicly available in an effort to drive research toward greater transparency and accessibility. These policies certainly have many benefits to the scientific community and public in helping ensure the quality of published research. However, the Center for Open Science has not offered any explicit guidelines regarding when exceptions to OS policies should be made, with only vague guidelines offered such as "when ethical or legal constraints prevent it." We argue that these ambiguous policies may create bias in decisions made by journal editors as to whom and what type of research is granted exceptions. When journals are too rigid in their exception policies, this may unintentionally contradict OS's goals to create a more valid and ethical science. We argue that journals should never mandate identifiable data to be posted publicly as a publication prerequisite. Maintaining participant anonymity should always come before OS policies to (a) align with psychologists' primary obligation of maintaining participant confidentiality, (b) encourage participation from the broader population and more specifically from marginalized communities, and (c) maintain unbiased, representative, and valid data. From empirical and ethical insights, we offer several solutions to ease the tensions between OS and participant privacy during the data collection and publication process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social identity and the mental health and wellbeing of male veterans.

BACKGROUND: Previous work has linked disruptions in one's social identity to increased levels of depression and suicide among veterans. This study examines the relationship between veteran social identity (as measured by the public and private regard subscales of the Warrior Identity Scale) and mental health and wellbeing among male veterans. PARTICIPANTS AND PROCEDURE: Male veterans (N = 67) completed the Warrior Identity Scale as well as various measures of mental health and wellbeing. RESULTS: The hypotheses were supported in that more positive views of one's social identity (i.e., more private regard) predicted significantly fewer post-traumatic stress disorder (PTSD) symptoms, less depression, suicidal ideation, anxiety, stress, and more perceived social support. More public regard, on the other hand, was related to more PTSD symptoms. CONCLUSIONS: This research adds to the growing work on the importance of social identity (as measured by public and private regard) in predicting mental health symptomatology among male veterans, which may act as important risk factors in clinical settings.

Systematic manipulation of experimenters' non-verbal behaviors for the investigation of pain reports and placebo effects.

Objective: Non-verbal behaviors (NBs) of caregivers affect pain reports and placebo effects. However, little experimental research has systematically examined the caregivers' NBs. This study protocol and preparatory study report a systematic manipulation of experimenters' NBs to investigate pain report and placebo effects. Methods: We propose an experiment in which videotaped experimenters (VEs) conduct a pain stimulation and a placebo treatment study. The VEs express one positively enhanced NB and keep the other NBs neutral. Participants will be randomized to either the positive facial expressions (+FE), tone of voice (+TV), body movement (+BM), or neutral NBs (i.e., neutral condition; NC) of the VEs. As a preparatory study for proof of concept, two groups of NB coders from Norway and the USA separately rated the degree of NBs (eye contact, body postures and movements, and tone of voice), and impressions of dominance and being in charge, positivity, and expressivity from each NB video. The NB videos had construct validity and reliability. The +BM and +FE were rated as more dominant and in charge than the +TV and the NC. The +FE and +BM were rated as the most positive and expressive NBs, respectively. Expected results: +FE will have the largest placebo effects on pain and stress levels. However, transmitting the NBs to patients by VEs is challenging. Moreover, controlling for the effects of research assistants present in the testing room is challenging. Discussion: We propose that caregivers' NBs affect pain reports and placebo effects. Moreover, different NBs elicit different impressions, and a better understanding of the role of caregiver NBs requires more rigorous investigations. Lastly, aiming to investigate the caregiver NBs, the varying degrees of micro-NBs and their effects on the formation of impressions should be considered.

"You Look Young! Are You a Doctor?" A Qualitative Content Analysis of Anesthesiology Resident Responses to Ageism in Clinical Encounters.

BACKGROUND: Healthcare trainees frequently report facing comments from their patients pertaining to their age. Exposure to ageist comments from patients may be related to greater stress and/or burnout in residents and may impact the quality of the resident-patient relationship. However, little empirical work has examined ageism expressed toward anesthesiology residents in clinical care, and therefore not much is known about how residents respond to these comments in practice. This research sought to determine how anesthesiology residents responded to ageist comments. METHODS: Anesthesiology residents (N = 60) engaged in a preoperative interaction with a standardized patient who was instructed to make an ageist comment to the resident. Resident responses were transcribed and coded using qualitative inductive content analysis to identify response themes. RESULTS: The most common resident response to the ageist comment, across gender and resident year, was to state their own experience. Some also described how they were still in training or that they were under supervision. Residents rarely reassured the patient that they would receive good care or identified the patient's anxiety as a cause of the ageist remark. CONCLUSIONS: These results provide a first step in understanding how ageism may be navigated by residents in clinical encounters. The authors discuss potential avenues for future research and education for responding to ageist remarks for both patients and clinicians.

Should I post? The relationships among social media use, emotion recognition, and mental health.

Introduction: While increased time spent on social media can be negatively related to one's overall mental health, social media research often fails to account for what behaviors users are actually engaging in while they are online. The present research helps to address this gap by measuring participants' active and passive social media behavioral styles and investigates whether and how these two social media behavioral styles are related to depression, anxiety, and stress, and the mediating role of emotion recognition ability in this relationship. Methods: A pre-study (N = 128) tested whether various social media behaviors reliably grouped into active and passive behavioral styles, and a main study (N = 139) tested the relationships between social media use style, emotion recognition, and mental health. Results: While we did not find evidence of a mediating relationship between these variables, results supported that more active social media use was related to more severe anxiety and stress as well as poorer emotion recognition skill, while passive social media use was unrelated to these outcomes. Discussion: These findings highlight that, beyond objective time spent on social media, future research must consider how users are spending their time online.

More Than Meets the Eyes: Bringing Attention to the Eyes Increases First Impressions of Warmth and Competence.

The present research examined how face masks alter first impressions of warmth and competence for different racial groups. Participants were randomly assigned to view photographs of White, Black, and Asian targets with or without masks. Across four separate studies (total N = 1,012), masked targets were rated significantly higher in warmth and competence compared with unmasked targets, regardless of their race. However, Asian targets benefited the least from being seen masked compared with Black or White targets. Studies 3 and 4 demonstrate how the positive effect of masks is likely due to these clothing garments re-directing attention toward the eyes of the wearer. Participants viewing faces cropped to the eyes (Study 3), or instructed to gaze into the eyes of faces (Study 4), rated these targets similarly to masked targets, and higher than unmasked targets. Neither political affiliation, belief in mask effectiveness, nor explicit racial prejudice moderated any hypothesized effects.

Discrimination Exposure Based on Race, Gender, and Sexual Orientation of Veterans Affairs Health Administration Patients.

This study contributes to research and policy aimed at reducing population-level health disparities by applying a Feminist Standpoint approach to the examination of rates and correlates of health care discrimination among patients at the Veterans Affairs Health Administration (VHA). Drawing on quality improvement survey data (N = 806) collected within the VHA in 2018, we document and describe rates of both direct and vicarious past-year exposure to health care discrimination disaggregated by race/ethnicity, sexual orientation, and gender. The analysis of within- and between-group rates and correlates of health care discrimination exposure reveals important subgroup-specific patterns that prior studies using aggregate or non-stratified data have masked. The findings have important research, theory, and policy implications and support advocacy for an intersectional approach to documenting and addressing health care discrimination.

A Formative Mixed-Methods Study of Emotional Responsiveness in Telepalliative Care.

Background: It is unknown whether telemedicine-delivered palliative care (tele-PC) supports emotionally responsive patient-clinician interactions. Objectives: We conducted a mixed-methods formative study at two academic medical centers in rural U.S. states to explore the acceptability, feasibility, and emotional responsiveness of tele-PC. Design: We assessed clinicians' emotional responsiveness through questionnaires, qualitative interviews, and video coding. Results: We completed 11 tele-PC consultations. Mean age was 71 years, 30% did not complete high school, 55% experienced at least moderate financial insecurity, and 2/3 rated their overall health poorly. All patients rated tele-PC as equal to, or better than, in-person PC at providing emotional support. There was a tendency toward higher positive and lower negative emotions following the consultation. Video coding identified 114 instances of patients expressing emotions, and clinicians detected and responded to 98% of these events. Conclusion: Tele-PC appears to support emotionally responsive patient-clinician interactions. A mixed-methods approach to evaluating tele-PC yields useful, complementary insights.

Empathy, friend or foe? Untangling the relationship between empathy and burnout in helping professions.

The relationship between empathy and burnout in helping professions has been debated extensively, with some arguing the tendency to vicariously experience the emotions of another is a risk factor for burnout and others arguing that this disposition protects against burnout. We sought to aid this debate by assessing the relationship between two empathy facets, positive and negative, and burnout across three samples of helping professionals: practicing clinicians (N = 59), medical students (N = 76), and teaching assistants (N = 77). Results across all three samples consistently revealed that one's tendency to share in the positive emotions of another (i.e., positive empathy) was related to lower levels of burnout, even after controlling for several potential confounding factors. Beyond discussing the utility of the emerging study of positive empathy, we offer potential avenues for reducing burnout in helping professions by emphasizing the importance of sharing in the positive emotions of others.

Veterans' Reported Comfort in Disclosing Sexual Orientation and Gender Identity.

BACKGROUND: The Veterans Health Administration (VHA) does not routinely collect and document sexual orientation and gender identity (SOGI) data despite research on health disparities among sexual and gender minority (SGM) veterans. Due to the legacy of previous Department of Defense policies that prohibited disclosure of sexual or gender minority identities among active-duty personnel, minority veterans may be reluctant to respond to SOGI questions on confidential VHA surveys and in discussions with their VHA providers. Veterans may generally find SOGI questions uncomfortable and may not appreciate their relevance to health care. OBJECTIVE: The purpose of this research was to examine veterans' comfort in reporting identity characteristics on confidential VHA surveys and in discussion with their VHA providers and whether comfort differed by sociodemographic characteristics. RESEARCH DESIGN: The project involves the secondary analysis of quantitative data from a quality improvement survey project. SUBJECTS: A total of 806 veterans were surveyed. RESULTS: Overall, 7.15% endorsed sexual or gender minority identity which is a higher rate than the 4.5% noted in the general US population. Cisgender and heterosexual veterans were more comfortable reporting identity characteristics both on VHA confidential surveys and in discussion with VHA providers compared with SGM veterans. CONCLUSIONS: These data suggest that the majority of veterans feel comfortable reporting their identities both on surveys and in the context of health care. Understanding these perceptions can assist VHA programs in implementing SOGI data collection and disclosure in clinical care, creating a welcoming environment of care for SGM veterans that does not make veterans from other backgrounds feel uncomfortable.

Greater belief in science predicts mask-wearing behavior during COVID-19.

We investigated whether and how individual's belief in science directly impacts reported face mask wearing behavior in the United States and the mediating role of belief in mask effectiveness in preventing transmission of COVID-19 in this relationship. Mechanical Turk participants (N = 1050) completed measures on reported face mask wearing behavior, general beliefs in science, belief in face mask effectiveness in reducing transmission of COVID-19, and sociodemographic information. We found evidence that greater belief in science predicted greater belief in the effectiveness of face masks reducing the transmission of COVID-19, which in turn predicted more reported face mask wearing behavior in public, controlling for sociodemographic factors. We urge researchers to engage in more open science practices and science education to increase the public's belief in science and the effectiveness of masks in reducing the transmission of COVID-19 in order to increase the frequency of face mask wearing in public.

Development of observational rating scales for evaluating patient-centered communication within a whole health approach to care.

CONTEXT: Teaching and evaluating patient-centered communication (PCC) skills that incorporate holistic approaches are increasingly relevant. OBJECTIVE: This study describes the development of the Observational Whole Health Measure (OWHM) for evaluating the extent to which primary care providers in the Veterans Health Administration engaged in PCC in the context of a holistic approach to care known as "Whole Health." DESIGN AND SETTING: Observational rating scales were created based on content from a national whole health clinical education program in the VA and refined from audio recordings of patient-provider interactions in primary care clinical encounters. Unpaired t-tests and Cohen's d were conducted to measure overall quality of what really matters and whole health goal setting and plan development. PARTICIPANTS: 65 clinical encounters across 8 providers before and after participating in the training were included for analysis. INTERVENTION: The intervention used for creating rating scales is a 2.5 day whole health clinical education program designed to teach providers PCC skills to identify what matters most for the patients and develop a patient-centered health plan that incorporates integrative health approaches to care. MAIN OUTCOME MEASURE: Quality scores (0-4) were used to measure number of instances and extent to which providers explored what matters most to patients, dimensions of whole health, and development of a whole health plan tailored to patient's goals. RESULTS: We developed the Observational Whole Health Measure (OWHM) that captures changes in provider communication. Significant differences in overall quality of whole health goal setting and plan development were detected between pre- and post-encounters, demonstrating a sensitivity to change. With the rise of integrative health approaches being adopted across clinical settings, the observational rating scales created in this study are likely to have increasing relevance.

Is Technology Enhancing or Hindering Interpersonal Communication? A Framework and Preliminary Results to Examine the Relationship Between Technology Use and Nonverbal Decoding Skill.

Digital technology has facilitated additional means for human communication, allowing social connections across communities, cultures, and continents. However, little is known about the effect these communication technologies have on the ability to accurately recognize and utilize nonverbal behavior cues. We present two competing theories, which suggest (1) the potential for technology use to enhance nonverbal decoding skill or, (2) the potential for technology use to hinder nonverbal decoding skill. We present preliminary results from two studies to test these hypotheses. Study 1 (N = 410) found that global screen time was unrelated to nonverbal decoding skill. However, how participants spent their time using technology mattered. Participants who reported more active technology use (i.e., posting content) self-reported that their nonverbal decoding skill (as measured by the Emotional Sensitivity subscale of the Social Skills Inventory) was superior but performed worse on objective measures of decoding skill (using standardized tests including the Diagnostic Analysis of Nonverbal Accuracy-Adult Faces and the Workplace Interpersonal Perception Skill). By contrast, passive users performed significantly better on objective measures of nonverbal decoding skill; although they did not self-report any difference in their skill compared to less passive users. Study 2 (N = 190), and a mini-meta analysis of both studies, replicated this pattern. These effects suggest a roadmap for understanding the theoretical relationship between technology use and nonverbal communication skills. We also provide recommendations for future research, including the use of experimental designs to determine causal pathways and to advance our conceptual understanding of the relationship between technology use and nonverbal decoding skill.

Compassionate and Clinical Behavior of Residents in a Simulated Informed Consent Encounter.

BACKGROUND: Compassionate behavior in clinicians is described as seeking to understand patients' psychosocial, physical and medical needs, timely attending to these needs, and involving patients as they desire. The goal of our study was to evaluate compassionate behavior in patient interactions, pain management, and the informed consent process of anesthesia residents in a simulated preoperative evaluation of a patient in pain scheduled for urgent surgery. METHODS: Forty-nine Clinical Anesthesia residents in year 1 and 16 Clinical Anesthesia residents in year 3 from three residency programs individually obtained informed consent for anesthesia for an urgent laparotomy from a standardized patient complaining of pain. Encounters were assessed for ordering pain medication, for patient-resident interactions by using the Empathic Communication Coding System to code responses to pain and nausea cues, and for the content of the informed consent discussion. RESULTS: Of the 65 residents, 56 (86%) ordered pain medication, at an average of 4.2 min (95% CI, 3.2 to 5.1) into the encounter; 9 (14%) did not order pain medication. Resident responses to the cues averaged between perfunctory recognition and implicit recognition (mean, 1.7 [95% CI, 1.6 to 1.9]) in the 0 (less empathic) to 6 (more empathic) system. Responses were lower for residents who did not order pain medication (mean, 1.2 [95% CI, 0.8 to 1.6]) and similar for those who ordered medication before informed consent signing (mean, 1.9 [95% CI, 1.6 to 2.1]) and after signing (mean, 1.9 [95% CI, 1.6 to 2.0]; F (2, 62) = 4.21; P = 0.019; partial η = 0.120). There were significant differences between residents who ordered pain medication before informed consent and those who did not order pain medication and between residents who ordered pain medication after informed consent signing and those who did not. CONCLUSIONS: In a simulated preoperative evaluation, anesthesia residents have variable and, at times, flawed recognition of patient cues, responsiveness to patient cues, pain management, and patient interactions.

Lesbian, Gay, Bisexual, and Transgender Veterans' Experiences of Discrimination in Health Care and Their Relation to Health Outcomes: A Pilot Study Examining the Moderating Role of Provider Communication.

Purpose: Lesbian, gay, bisexual, and transgender (LGBT) veterans report discrimination in health care, which may be associated with negative health outcomes/behaviors and has implications for LGBT identity disclosure to providers. Quality provider communication may serve to offset some of the deleterious effects of discrimination; however, no research to date has examined provider communication with respect to health among LGBT patients. Methods: Participants were 47 LGBT veterans who completed measures related to past health care experiences, experiences of discrimination in health care, perceptions of provider communication, and measures of anxiety, depression, post-traumatic stress disorder symptoms, and alcohol/tobacco use. Results: The majority of LGBT veterans reported experiencing LGBT-based discrimination in health care, which was associated with higher rates of tobacco use and less comfort in disclosing their LGBT identity to providers. We also found evidence of moderation, such that high-quality provider communication appeared to buffer these associations. Conclusion: LGBT veterans face unique challenges with respect to receiving appropriate health care. The high frequencies of reported discrimination in health care is problematic and warrants further research and intervention. These results highlight the important role of provider communication, and the potential for quality communication to buffer against certain effects, particularly with respect to tobacco use and LGBT identity disclosure, which is an important protective factor.

Experiences of trauma, discrimination, microaggressions, and minority stress among trauma-exposed LGBT veterans: Unexpected findings and unresolved service gaps.

OBJECTIVE: LGBT veterans experience high rates of trauma, discrimination, and minority stress. However, guidelines for case conceptualization and treatment remain limited. The aim of the current study was to examine the experiences of trauma and other high impact experiences among LGBT veterans to inform case conceptualization and treatment. METHOD: We recruited 47 LGBT veterans with a history of exposure to LGBT-related Criterion A trauma and performed semistructured interviews about their experiences in trauma treatment, barriers to engagement, and treatment needs and preferences. We used thematic analysis of qualitative codes guided by inductive and deductive approaches to characterize the variety of trauma and high impact experiences reported. RESULTS: LGBT veterans disclosed a range of clinically relevant stressors, including Criterion A traumatic events, minority stress, and microaggression experiences, including interpersonal and institutional discrimination perpetrated by fellow service members/veterans, citizens, therapy group members, and health care providers. CONCLUSION: These data provide a unique account of LGBT veteran's identity-related trauma and concomitant interpersonal and institutional discrimination, microaggression experiences, minority stress, and traumatic stress symptoms. Findings highlight existing service gaps regarding evidence-based treatments for the sequalae of trauma, discrimination, microaggressions, and minority stress. In addition, we noted past and present issues in military and health care settings that may lead to or exacerbate trauma-related distress and discourage treatment seeking among LGBT veterans. We provide suggestions for clinical work with LGBT veterans and encourage ongoing research and development to eliminate remaining service gaps. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictive Validity of Thin-Slice Nonverbal Behavior from Social Interactions.

We present five studies investigating the predictive validity of thin slices of nonverbal behavior (NVB). Predictive validity of thin slices refers to how well behavior slices excerpted from longer video predict other measured variables. Using six NVBs, we compared predictive validity of slices of different lengths with that obtained when coding is based on full-length (5-min) video, investigating the relative predictive validity of 1-min slices as well as of cumulative slices. Results indicate some loss in predictive validity with 1-min slices, but relatively little loss when Slices 1 and 2 were combined for five of the six NVBs. This research establishes an empirical basis on which researchers can decide how much of their recorded corpus needs to be coded for NVB. The results also provide some guidance on effect sizes in power analyses for researchers coding specific behaviors in a thin-slice design.

Measuring nonverbal behavior in clinical interactions: A pragmatic guide.

OBJECTIVE: Understanding nonverbal behavior is key to the research, teaching, and practice of clinical communication. However, the measurement of nonverbal behavior can be complex and time-intensive. There are many decisions to make and factors to consider when coding nonverbal behaviors. METHODS: Based on our experience conducting nonverbal behavior research in clinical interactions, we developed practical advice and strategies for coding nonverbal behavior in clinical communication, including a checklist of questions to consider for any nonverbal coding project. RESULTS: We provide suggestions for beginning the nonverbal coding process, operationalizing the coding approach, and conducting the coding. CONCLUSION: A key to decision-making around nonverbal behavior coding is establishing clear research questions and using these to guide the process. PRACTICE IMPLICATIONS: The field needs more coding of nonverbal behavior to better describe what happens in clinical interactions, to understand why nonverbal behaviors occur, and to determine the predictors and consequences of nonverbal behaviors in clinical interactions. A larger evidence base can inform better teaching practices and communication interventions.