The healing relationship in Indigenous patients' pain care: Influences of racial concordance and patient ethnic salience on healthcare providers' pain assessment

  • Michelle Johnson-Jennings
  • Wassim Tarraf
  • Hector M. González
Keywords: Indigenous health, pain, pain disparities, patient-provider relationship, racial concordance, patient ethnic salience, American Indian health, pain assessment, medical decision-making


Indigenous persons suffer from among the highest rates of chronic pain in the United States. Using a relationship-centered medical decision-making framework, this study sought to examine the influence of Indigenous racial concordance and patient ethnic salience on providers’ assessment of pain. From May to October 2010, pre-identified healthcare providers working exclusively with Indigenous patients in the United States were randomly assigned an online clinical case vignette presenting an Indigenous patient reporting chronic lower back pain. A 2 × 2 analysis of variance, between-subjects design, was conducted with the predictor variables racial concordance and patient ethnic salience on the outcome measure of providers’ ratings of patient’s pain on a visual analogue scale. We found a significant interactional effect between racial concordance and patient ethnic salience on providers’ pain assessment ratings. Indigenous providers tended to rate the patient with higher Indigenous ethnic salience more congruently with the self-reported pain ratings, perhaps due to perceived similarities and lowered unconscious bias. This is the first known study to examine racial concordance of the healthcare provider and ethnic salience of the patient in pain care. This study informs healthcare provider practice and consideration of patients’ racial/cultural attributes and possible influence on assessment bias, which may be particularly relevant among Indigenous patients. More research is needed to identify specific interventions to improve cultural awareness and sensitivity for Indigenous persons who suffer from pain.

Research Papers