(576) Biases in the management of postpartum pain: a qualitative analysis of clinicians’ perspectives

Racial/ethnic disparities in the management of postpartum pain are known to exist. Our objective was to evaluate clinician biases which may contribute to disparities in postpartum pain management.


Study Design:

This is a qualitative study of obstetric clinicians at a large, tertiary, academic center (11/2021-6/2022). Using a structured interview guide, attending physicians, trainee physicians, and advanced practice providers, underwent in-depth interviews examining factors which influence their approach to postpartum pain management and perspectives on biases which may contribute to disparities in pain management. Purposive sampling was used to enroll a cohort representative of our obstetric workforce in terms of clinician roles and race/ethnicity. Data were analyzed using the constant comparative method.


Results:

Of 46 participants, 48% (N=22) were attending physicians and 33% (N=15) identified as minority race/ethnicity. Data demonstrated sources of clinician bias were related to 4 major themes: socioeconomic status (SES), clinical history, communication mode, and race (Table 1). Clinicians believed that biases related to SES and clinical characteristics, such as a substance use history, often led to a perception that pain was related to drug-seeking behaviors. Clinicians also noted that pain control was biased by modes of communication, specifically reporting that they believed language and cultural differences in the expression of pain impacted pain management. Additionally, racial biases that were perceived to affect pain management were identified, including the perceptions of racial differences in pain tolerance and not believing minority patients’ reports of pain. Finally, clinicians reported that they used strategies to counteract biases (Table 2), including self-awareness of biases, taking actions to account for known biases, and standardizing approaches to pain management.


Conclusion:

Clinician biases in postpartum pain management are perceived to be pervasive. Efforts to increase awareness and account for these biases is essential to providing equitable postpartum pain management.