# Examining the effects of contextually-imposed cognitive load on providers' chronic pain treatment decisions for racially and socioeconomically diverse patients

> **NIH NIH F31** · INDIANA UNIVERSITY INDIANAPOLIS · 2020 · $44,150

## Abstract

Project Summary/Abstract
Compared to individuals who are White and have high socioeconomic status (SES), those who are Black and
have low SES experience greater pain and disability and are more likely to receive suboptimal pain care. One
potential contributor to these disparities is biased provider decision-making. There is compelling evidence that
providers are influenced by patient race and SES when making treatment decisions. Pain is subjective, and
providers often make pain care decisions with insufficient information. Consequently, providers may fill these
information gaps with stereotypes about race and SES groups, leading to systematic differences in pain care.
According to the dual process model (DPM) and previous studies, people are more likely to use such
stereotypes when they are under high cognitive load (i.e., mental workload). Health care settings place high
cognitive demands on providers via time pressures, noises levels, and interruptions. Another factor that may
contribute to biased provider decision-making is implicit beliefs (subconscious, automatic stereotyping), which
have been found to be associated with health care disparities. One stereotype belief relevant to pain care is
that Black and low SES individuals are more pain tolerant. Previous studies suggest that many providers hold
these beliefs about pain tolerance. Consistent with the DPM, providers who are under high cognitive load and
who have strong beliefs that Black and low SES people are more pain tolerant may be particularly likely to
recommend fewer pain treatments for Black and low SES patients. To test these hypotheses, the proposed
study will recruit physician residents and fellows to view videos and make pain treatment decisions for 12
computer-simulated patients with low back pain that vary by race (Black/White) and SES (low/high); treatment
options will include analgesic medications, complementary and alternative approaches, lifestyle changes, and
referrals to specialty care. Half of the providers will be randomized to the high cognitive load group in which
they will be interrupted during the treatment decision task to make Morphine Equivalent Dose conversions.
Providers in the control group will not be interrupted during the treatment decision task. Providers’ implicit
beliefs about race and SES differences in pain tolerance will be measured with Implicit Association Tests. The
primary analyses will examine the main and interaction effects of patient race and SES on providers’ treatment
decisions for chronic pain (aim 1), examine the main and interaction effects of patient race [SES] and cognitive
load on providers’ treatment decisions (aim 2), and examine the main and interaction effects of patient race
[SES], cognitive load, and providers’ implicit beliefs about race [SES] differences in pain tolerance on
providers’ treatment decisions (aim 3). Multilevel modeling will allow for the examination of these effects at the
individual provider and group levels. ...

## Key facts

- **NIH application ID:** 9989635
- **Project number:** 5F31MD014058-02
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** Tracy Anastas
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $44,150
- **Award type:** 5
- **Project period:** 2019-08-01 → 2021-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9989635

## Citation

> US National Institutes of Health, RePORTER application 9989635, Examining the effects of contextually-imposed cognitive load on providers' chronic pain treatment decisions for racially and socioeconomically diverse patients (5F31MD014058-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9989635. Licensed CC0.

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