Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-26T04:16:49.455Z Has data issue: false hasContentIssue false
  • English
  • Français

The Influence of Gender Bias: Is Pain Management in the Field Affected by Health Care Provider’s Gender?

Published online by Cambridge University Press:  04 August 2022

Adi Karas Open the ORCID record for Adi Karas [Opens in a new window] ,
Lidar Fridrich ,
Irina Radomislensky ,
Guy Avital ,
Sami Gendler ,
Jacob Chen Open the ORCID record for Jacob Chen [Opens in a new window] ,
Shaul Gelikas  and
Avi Benov
Adi Karas*
Affiliation:
Trauma and Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
Lidar Fridrich
Affiliation:
Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Irina Radomislensky
Affiliation:
Trauma and Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
Guy Avital
Affiliation:
Trauma and Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
Sami Gendler
Affiliation:
Trauma and Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
Jacob Chen
Affiliation:
Hospital Management, Meir Medical Center, Kfar Saba; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Shaul Gelikas
Affiliation:
Trauma and Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel Department of Internal Medicine E, Sheba Medical Center, Tel Hashomer, Israel
Avi Benov
Affiliation:
Trauma and Combat Medicine Branch, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
*
Correspondence: Adi Karas, MD The Trauma and Combat Medicine Branch Surgeon General’s Headquarters Ramat Gan, Israel Email: Adikarass@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings.

Study Objective:

The purpose of this study is to investigate the effect of health care providers’ gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams.

Methods:

This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider’s gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for “delta-pain,” defined as the difference in pain score during treatment.

Results:

A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups.

Conclusion:

This study found no association between IDF Medical Corps providers’ gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.

Keywords

gender biaspain managementprehospitalprovider gendertrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 5 , October 2022 , pp. 638 - 644
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Note: SG and AB contributed to the manuscript equally and are co-last authors.

References

Buckenmaier, CC, Rupprecht, C, McKnight, G, et al. Pain following battlefield injury and evacuation: a survey of 110 casualties from the wars in Iraq and Afghanistan. Pain Med. 2009;10(8):1487–1496.CrossRefGoogle ScholarPubMed
McLean, SA, Maio, RF, Domeier, RM. The epidemiology of pain in the prehospital setting. Prehosp Emerg Care. 2002;6(4):402–405.CrossRefGoogle ScholarPubMed
Friesgaard, KD, Riddervold, IS, Kirkegaard, H, Christensen, EF, Nikolajsen, L. Acute pain in the prehospital setting: a register-based study of 41.241 patients. Scand J Trauma Resusc Emerg Med. 2018;26(1):53.CrossRefGoogle ScholarPubMed
Connor, JP, Brier, ZMF, Price, M. The association between pain trajectories with posttraumatic stress disorder, depression, and disability during the acute post-trauma period. Psychosom Med. 2020;82(9):862–868.CrossRefGoogle Scholar
Berben, SAA, Schoonhoven, L, Meijs, THJM, van Vugt, AB, van Grunsven, PM. Prevalence and relief of pain in trauma patients in Emergency Medical Services. Clin J Pain. 2011;27(7):587–592.CrossRefGoogle ScholarPubMed
Thomas, SH, Shewakramani, S. Prehospital trauma analgesia. J Emerg Med. 2008;35(1):47–57.CrossRefGoogle ScholarPubMed
Sinatra, R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859–1871.CrossRefGoogle ScholarPubMed
Herrera-Escobar, JP, Apoj, M, Weed, C, et al. Association of pain after trauma with long-term functional and mental health outcomes. J Trauma Acute Care Surg. 2018;85(4):773–779.CrossRefGoogle ScholarPubMed
Morone, NE, Weiner, DK. Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther. 2013;35(11):1728–1732.CrossRefGoogle Scholar
Campbell, JN. APS 1995 Presidential Address. Pain Forum. 1996;5(1):85–88.CrossRefGoogle Scholar
Department of Veterans Affairs (VA). Pain as the 5th Vital Sign Toolkit. Washington, DC USA: VA; 2000.Google Scholar
Heins, JK, Heins, A, Grammas, M, Costello, M, Huang, K, Mishra, S. Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs. 2006;32(3):219–224.CrossRefGoogle ScholarPubMed
Albrecht, E, Taffe, P, Yersin, B, Schoettker, P, Decosterd, I, Hugli, O. Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study. Br J Anaesth. 2013;110(1):96–106.CrossRefGoogle ScholarPubMed
Anderson, KO, Green, CR, Payne, R. Racial and ethnic disparities in pain: causes and consequences of unequal care. J Pain. 2009;10(12):1187–1204.CrossRefGoogle ScholarPubMed
Mossey, JM. Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res. 2011;469(7):1859–1870.CrossRefGoogle ScholarPubMed
Lee, P, le Saux, M, Siegel, R, et al. Racial and ethnic disparities in the management of acute pain in US emergency departments: meta-analysis and systematic review. Am J Emerg Med. 2019;37(9):1770–1777.CrossRefGoogle ScholarPubMed
Zohar, Z, Eitan, A, Halperin, P, et al. Pain relief in major trauma patients: an Israeli perspective. J Trauma. 2001;51(4):767–772.CrossRefGoogle Scholar
Rupp, T, Delaney, KA. Inadequate analgesia in emergency medicine. Ann Emerg Med. 2004;43(4):494–503.CrossRefGoogle ScholarPubMed
Samulowitz, A, Gremyr, I, Eriksson, E, Hensing, G. “Brave Men” and “Emotional Women:” a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag. 2018;2018:1–14.CrossRefGoogle ScholarPubMed
Hoffmann, DE, Tarzian, AJ. The girl who cried pain: a bias against women in the treatment of pain. J Law Med Ethics. 2001;29(1):13–27.CrossRefGoogle ScholarPubMed
Chen, EH, Shofer, FS, Dean, AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med. 2008;15(5):414–418.CrossRefGoogle ScholarPubMed
Champagne-Langabeer, T, Hedges, AL. Physician gender as a source of implicit bias affecting clinical decision-making processes: a scoping review. BMC Med Educ. 2021;21(1):171.CrossRefGoogle ScholarPubMed
OECD. Health Care Resources: Physicians by age and gender. https://stats.oecd.org/index.aspx?queryid=30172#. Accessed January 26, 2022.Google Scholar
Association of American Medical Colleges. Active Physicians by Sex and Specialty, 2019. Data & Reports: Physician Specialty Data Report. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2019. Accessed January 26, 2022.Google Scholar
von Elm, E, Altman, DG, Egger, M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–808.CrossRefGoogle ScholarPubMed
Betelman Mahalo, Y, Avital, G, Radomislensky, I, et al. Pain management for casualties receiving lifesaving interventions in the prehospital scenario: raising awareness of our human nature. J Trauma Acute Care Surg. 2021;91(2S Suppl 2):S201–205.CrossRefGoogle ScholarPubMed
Robinson, ME, Wise, EA. Gender bias in the observation of experimental pain. Pain. 2003;104(1-2):259–264.CrossRefGoogle ScholarPubMed
Bartley, EJ, Boissoneault, J, Vargovich, AM, et al. The influence of health care professional characteristics on pain management decisions. Pain Med. 2015;16(1):99–111.CrossRefGoogle ScholarPubMed
Weisse, CS, Sorum, PC, Sanders, KN, Syat, BL. Do gender and race affect decisions about pain management? J Gen Intern Med. 2001;16(4):211–217.CrossRefGoogle ScholarPubMed
Green, AD, Tripp, DA, Sullivan, MJL, Davidson, M. The relationship between empathy and estimates of observed pain. Pain Med. 2009;10(2):381–392.CrossRefGoogle ScholarPubMed
Gingras, C, Coll, MP, Tessier, MH, Tremblay, P, Jackson, PL. Pain evaluation and prosocial behavior are affected by age and sex. Eur J Pain. 2021;25(9):1925–1937.CrossRefGoogle ScholarPubMed
Hirsh, AT, Hollingshead, NA, Matthias, MS, et al. The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions. J Pain. 2014;15(5):551–559.CrossRefGoogle ScholarPubMed
Raftery, KA, Smith-Coggins, R, Chen, AH. Gender-associated differences in emergency department pain management. Ann Emerg Med. 1995;26(4):414–421.CrossRefGoogle ScholarPubMed
Safdar, B, Heins, A, Homel, P, et al. Impact of physician and patient gender on pain management in the emergency department-a multicenter study. Pain Med. 2009;10(2):364–372.CrossRefGoogle ScholarPubMed
Oberholzer, N, Kaserer, A, Albrecht, R, et al. Factors influencing quality of pain management in a physician staffed helicopter emergency medical service. Anesth Analg. 2017;125(1):200–209.CrossRefGoogle Scholar
Kiavialaitis, GE, Müller, S, Braun, J, et al. Clinical practice of pre-hospital analgesia: an observational study of 20,978 missions in Switzerland. Am J Emerg Med. 2020;38(11):2318–2323.CrossRefGoogle ScholarPubMed
Siriwardena, AN, Asghar, Z, Lord, B, et al. Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study. Am J Emerg Med. 2019;37(2):266–271.CrossRefGoogle ScholarPubMed
Woolf, SH, Grol, R, Hutchinson, A, Eccles, M, Grimshaw, J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527–530.CrossRefGoogle ScholarPubMed
Benov, A, Salas, MM, Nakar, H, et al. Battlefield pain management: a view of 17 years in Israel Defense Forces. J Trauma Acute Care Surg. 2017;83(1 Suppl 1):S150–155.CrossRefGoogle ScholarPubMed
Vysokovsky, M, Avital, G, Betelman-Mahalo, Y, et al. Trends in prehospital pain management following the introduction of new clinical practice guidelines. J Trauma Acute Care Surg. 2021;91(2S):S206–212.CrossRefGoogle ScholarPubMed