Florida College

Racial, ethnic, and socioeconomic disparities in pain severity and treatment persist across healthcare settings, reflecting inequities shaped by patients' experiences of discrimination and bias. Perceived healthcare discrimination (PHCD), feeling dismissed, disrespected, or treated unfairly by healthcare providers, may contribute to persistent pain disparities among socially disadvantaged populations, yet its independent role relative to everyday discrimination remains underexplored. Using cross-sectional data from the All of Us Research Program, we examined associations between PHCD and pain severity among 89,069 participants from the Registered Tier Dataset (v7, R2022Q4R9), excluding individuals with missing data or non-categorized racial identities. Multinomial logistic regression models adjusted for age, sex, race/ethnicity, income, and education were used to estimate odds ratios (ORs) for pain severity. Both occasional and frequent PHCD were significantly associated with higher odds of mild, moderate, and severe pain (all p <.001). Participants reporting frequent PHCD had nearly eightfold higher odds of severe pain compared with those reporting no discrimination (OR = 7.98, 95% CI: 6.85-9.30). These associations persisted after full covariate adjustment, demonstrating a clear dose-response relationship between discrimination frequency and pain severity. PHCD emerged as a robust and independent predictor of pain severity in a large, diverse national sample, highlighting discrimination as a modifiable social determinant of pain and underscoring the need for equity-focused clinical communication and systemic interventions to improve pain management. PERSPECTIVE: This study, the largest to date examining perceived healthcare discrimination, demonstrates a significant association with greater pain severity across diverse populations. Highlighting a critical social determinant of health, these findings underscore the importance of addressing discrimination within clinical care. Integrating equity-focused strategies into pain assessment and management is essential to reduce disparities and improve outcomes among marginalized communities.

BackgroundBrepocitinib is a first-in-class, oral, selective TYK2–JAK1 inhibitor that blocks cytokine signaling, which has been implicated in dermatomyositis.MethodsIn this phase 3, double-blind, randomized, placebo-controlled trial, adults with dermatomyositis were assigned in a 1:1:1 ratio to receive once-daily oral brepocitinib at a dose of 30 mg, brepocitinib at a dose of 15 mg, or placebo for 52 weeks. Standard therapies were continued, and glucocorticoids were tapered. The primary end point was the Total Improvement Score, a validated composite myositis index (with scores ranging from 0 to 100 and higher scores indicating greater improvement) at week 52. Key secondary end points, including skin disease activity, glucocorticoid tapering, and physical function, were tested in a multiplicity-controlled sequence.ResultsA total of 241 patients underwent randomization: 81 to receive brepocitinib 30 mg, 81 to receive brepocitinib 15 mg, and 79 to receive placebo. At week 52, the mean Total Improvement Score was 46.5, 37.5, and 31.2, respectively (difference with brepocitinib 30 mg vs. placebo, 15.3; 95% confidence interval [CI], 6.7 to 24.0; P<0.001; difference with brepocitinib 15 mg vs. placebo, 6.3; 95% CI, −2.4 to 14.9). Brepocitinib 30 mg was superior to placebo across all nine key secondary end points, including skin disease activity, systemic glucocorticoid tapering, and functional disability, with improvements observed as early as week 4. Serious infections were more frequent in the brepocitinib 30-mg group than in the placebo group (10% vs. 1%). No deaths occurred during the trial.ConclusionsIn adults with dermatomyositis that was resistant to previous therapy, the use of brepocitinib at a dose of 30 mg (but not at a dose of 15 mg) resulted in significant benefits with respect to a composite myositis index, skin disease severity, glucocorticoid tapering, and functional disability. (Funded by Priovant Therapeutics; ClinicalTrials.gov number, NCT05437263.)

Genetic counselors (GCs) utilize a variety of skills while counseling patients. However, it remains unclear whether the frequency or types of skills used impact patient outcomes. We explored the use of specific GC communication skills in cardiology and their impact on empowerment and therapeutic alliance. Adults attending an initial cardiovascular GC appointment completed pre-visit and post-visit surveys. Measures included the Genetic Counseling Outcomes Scale (GCOS) and the Working Alliance Inventory (WAI). GC appointments were audio-recorded, transcribed, and coded using the Genetic Counseling Skills Checklist (GCSC). WAI and change in GCOS scores following the GC visit were stratified into high- and low-scoring groups for comparative analyses. Descriptive analyses were used to identify GCSC code patterns across sessions with high and low WAI and GCOS scores. Seventeen participants (65% female, mean age: 61 years) completed the study. Cases from seven GCs were included across four indications: cardiomyopathy, arrhythmia, dyslipidemia, and aortopathy. There was an increase in empowerment after GC appointments (p = 0.0007), with nearly half (8/17) of participants exhibiting a clinically meaningful increase. Sessions showed a diverse set of skills used across eight domains on the GCSC. Skills around mutual agenda setting, focus on patients' emotions, and facilitating decision-making were used more frequently in higher WAI-scoring sessions. However, when comparing participants who exhibited clinically meaningful changes in empowerment to those who did not, there was little difference in the skills used in sessions, though some skills may have been used more frequently with patients who demonstrated smaller changes in empowerment (e.g., eliciting ways to overcome barriers to taking action). This is the first application of the GCSC in nonsimulated patient settings. We observed trends suggesting varying use of GC skills may contribute to differences in therapeutic alliance and that GCs alter the skills they use for different patients.