Investigating Gender Fairness in Machine Learning-driven Personalized Care for Chronic Pain

Chronic pain significantly diminishes the quality of life for millions worldwide. While psychoeducation and therapy can improve pain outcomes, many individuals experiencing pain lack access to evidence-based treatments or fail to complete the necessary number of sessions to achieve benefit. Reinforcement learning (RL) shows potential in tailoring personalized pain management interventions according to patients' individual needs while ensuring the efficient use of scarce clinical resources. However, clinicians, patients, and healthcare decision-makers are concerned that RL solutions could exacerbate disparities associated with patient characteristics like race or gender. In this article, we study gender fairness in personalized pain care recommendations using a real-world application of reinforcement learning (Piette et al., 2022a). Here, adhering to gender fairness translates to minimal or no disparity in the utility received by subpopulations as defined by gender. We investigate whether the selection of relevant patient information (referred to as features) used to assist decision-making affects gender fairness. Our experiments, conducted using real-world data Piette, 2022), indicate that included features can impact gender fairness. Moreover, we propose an RL solution, NestedRecommendation, that demonstrates the ability: i) to adaptively learn to select the features that optimize for utility and fairness, and ii) to accelerate feature selection and in turn, improve pain care recommendations from early on, by leveraging clinicians' domain expertise.