# Racial Disparities in Pain Care: A Comprehensive Integration of Patient- and Provider-Level Mechanisms with Dyadic Communication Processes Using a Mixed-Methods Research Design

> **NIH NIH R01** · UNIVERSITY OF VIRGINIA · 2024 · $455,562

## Abstract

Despite decades of efforts to reduce racial pain disparities, the pain of Black patients is still undertreated. As
persistent pain experience robustly predicts poorer quality of life overall, racial pain care disparities represent a
central factor fueling larger social inequalities. While previous work has identified a host of patient and provider
factors that contribute to racial disparities in healthcare in general and thus also likely contributing to disparities
in pain care, there has been limited clinically-meaningful progress in eliminating these disparities. Thus, there is
an urgent need to address this decades-old inequity by taking an innovative approach. We argue that this lack
of progress is due to the fact that prior research has investigated the influence of patient and provider factors in
isolation, rather than examining their interaction. Successful pain care requires constructive patient-provider
communication, and constructive communication is both dyadic and dynamic. This proposed research will
establish the dyadic and dynamic processes underlying patient-provider communication as the key
mechanism through which patient and provider factors contribute to racial disparities in both patient-
centered and clinical pain outcomes. One well-accepted operationalization of such dyadic processes is
behavioral coordination (i.e., spatial/temporal matching in the rhythms or patterns of behaviors between
individuals engaged in an interaction, such as synchrony, leader-and-follower dynamics, and turn-taking). We
hypothesize that the pain of Black patients continues to be undertreated because Black (vs. White) patients are
more likely to participate in racially discordant medical interactions (i.e., seeing other-race providers) and as a
result, are more likely to experience disruptions in behavioral coordination. These hypotheses will be tested
within the context of preoperative consultations because racial disparities in surgical pain outcomes are well-
documented across procedures, and further, the quality of preoperative consultations is linked to post-surgical
pain management. We will use a convergent mixed methods research design to assess behavioral coordination
quantitatively (e.g., levels, duration, patterns) and qualitatively (e.g., valence, discussion themes). This work will:
Aim 1) compare the levels, duration, patterns, and context of behavioral coordination in preoperative
consultations (both overall and during pain discussion specifically) between Black and White patients; Aim 2)
elucidate links between patient/provider factors and coordination in preoperative consultations; and Aim 3)
identify specific aspects of behavioral coordination in preoperative consultations that contribute to racial
disparities in post-surgical patient-centered outcomes (e.g., pain management self-efficacy, quality of life) and
clinical outcomes (e.g., pain level, prescriptions). Since this research focuses on pain management self-efficacy
and quality ...

## Key facts

- **NIH application ID:** 10930968
- **Project number:** 5R01NR020030-03
- **Recipient organization:** UNIVERSITY OF VIRGINIA
- **Principal Investigator:** Nao Hagiwara
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $455,562
- **Award type:** 5
- **Project period:** 2023-09-18 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10930968

## Citation

> US National Institutes of Health, RePORTER application 10930968, Racial Disparities in Pain Care: A Comprehensive Integration of Patient- and Provider-Level Mechanisms with Dyadic Communication Processes Using a Mixed-Methods Research Design (5R01NR020030-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10930968. Licensed CC0.

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