186 - Language Matters: The Role of Patient-Centered versus Provider-Focused Language on Pain Management Decisions Among Pediatric Residents

Publication Number: 186.5843

Andrea Pinto, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Alexandria Laws, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Terri L. Major-Kincade, UT Health Houston MCGovern Medical School, Richardson, TX, United States; Chinyere O’Connor, UTHealth Houston, Houston, TX, United States

Background: Stigmatizing language in healthcare primarily manifests through labeling patients and using terms that reinforce negative perceptions. This often can influence physicians' attitudes and prescribing behaviors, particularly in marginalized groups. Studies on how these biases are propagated during pediatric residents’ hand-offs are lacking.

Objective: To examine whether stigmatizing language in patient notes is perpetuated to other residents and leads to an underestimation of a patient’s pain.

Design/Methods: We conducted an experimental vignette study where residents evaluated a chart note for a hypothetical patient with sickle cell disease requesting "dilaudid and benadryl" for severe pain (10/10). The case included stigmatizing language, such as “sickler,” “frequent flyer,” and “non-compliance.” Our primary outcomes measured the use of stigmatizing language in residents’ assessments and adjustments made to the pain regimen. Debriefing was conducted after the session.

Residents were randomized into groups: PGY-1s alongside PGY-2s and PGY-3s (T1). Each resident independently wrote an assessment before discussing a unified approach. A new resident (T2) joined each group for a verbal handoff, followed by documentation of their assessment and plan. Kruskal-Wallis and chi-squared test evaluated differences between classes, while content and thematic analysis examined the use of stigmatizing language.

Results: Fifty T1 residents participated: 29 PGY-1, 12 PGY-2, and 9 PGY-3. There was no significant difference among PGY classes in adjusting the pain regimen [4/9 (44%) PGY-3 vs. 8/12 (67%) PGY-2 vs. 13/29 (45%) PGY-1; p-value=0.5]. Stigmatizing labels within the notes included “drug-seeking,” “addicted,” “sickler,” and “presumed refractory pain.”

Of the T1 residents who did not adjust the regimen, 11/25 (44%) used provider-focused terms like "pain reportedly worse," “non-compliant,” and "sickle cell crisis" (Table 1). In contrast, among the T1 residents who adjusted the regimen, 20/25 (80%) used patient-centered language such as "severe pain crisis," “he responds best to” and "lack of improvement in pain” (p-value < 0.01) (Table 1). Compared to T1 residents, only 5/12 (41%) T2 residents adjusted the pain regimen (p-value > 0.05).

Conclusion(s): Focusing on the patient’s experience led to more appropriate adjustments in pain management. Addressing bias in pediatric trainees involves recognizing stigmatizing language as a barrier to care and educating residents on adopting a patient-centered approach to avoid linguistic marginalization during hand-offs.

Thematic Analysis of T1 Resident's Written Assessments Regarding Treatment Decision
Direct quotes of residents' assessment in group T1 categorized based on the use of common themes of patient-centered versus provider-focused language.