Racial, ethnic, and sex bias in large language model opioid recommendations for pain management.
Pain
; 2024 Sep 06.
Article
en En
| MEDLINE
| ID: mdl-39283333
ABSTRACT
ABSTRACT Understanding how large language model (LLM) recommendations vary with patient race/ethnicity provides insight into how LLMs may counter or compound bias in opioid prescription. Forty real-world patient cases were sourced from the MIMIC-IV Note dataset with chief complaints of abdominal pain, back pain, headache, or musculoskeletal pain and amended to include all combinations of race/ethnicity and sex. Large language models were instructed to provide a subjective pain rating and comprehensive pain management recommendation. Univariate analyses were performed to evaluate the association between racial/ethnic group or sex and the specified outcome measures-subjective pain rating, opioid name, order, and dosage recommendations-suggested by 2 LLMs (GPT-4 and Gemini). Four hundred eighty real-world patient cases were provided to each LLM, and responses included pharmacologic and nonpharmacologic interventions. Tramadol was the most recommended weak opioid in 55.4% of cases, while oxycodone was the most frequently recommended strong opioid in 33.2% of cases. Relative to GPT-4, Gemini was more likely to rate a patient's pain as "severe" (OR 0.57 95% CI [0.54, 0.60]; P < 0.001), recommend strong opioids (OR 2.05 95% CI [1.59, 2.66]; P < 0.001), and recommend opioids later (OR 1.41 95% CI [1.22, 1.62]; P < 0.001). Race/ethnicity and sex did not influence LLM recommendations. This study suggests that LLMs do not preferentially recommend opioid treatment for one group over another. Given that prior research shows race-based disparities in pain perception and treatment by healthcare providers, LLMs may offer physicians a helpful tool to guide their pain management and ensure equitable treatment across patient groups.
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1
Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
Pain
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Estados Unidos