A Qualitative Study of the Pain Experience of Black Individuals With Cancer Taking Long-Acting Opioids

Abstract

BackgroundLittle is known about the experience of Black individuals with cancer taking long-acting opioids for cancer pain.ObjectiveThis study aimed to describe the day-to-day experience of living with pain and the experiences of taking opioids for pain management among Black individuals with cancer prescribed with long-acting opioids.MethodsThis qualitative descriptive study was part of a larger investigation focused on opioid adherence. Participants (N = 14) were interviewed using a semistructured interview guide. Analysis followed conventional content analysis and constant comparison approaches. Sociodemographics, clinical information, and the Brief Pain Inventory form were collected.ResultsThe majority of the subsample was female (64.3%), not married (78.6%), and with a median age of 52.5 years. Participants were taking either MS Contin (85.7%) or OxyContin (14.3%). The Brief Pain Inventory median “average” pain severity scores and pain interference scores were 5.1/10 (interquartile range [IQR] = 6.1) and 3.5/10 (IQR = 6.7), respectively. Three themes are reported from the analyses: desire for control, barriers to pain relief, and isolation versus connectedness.ConclusionOur findings highlight the persistent nature of moderate to severe cancer pain and how pain and its treatment interfere with patients’ lives. The findings describe ways that patients learn to manage and exert control over pain despite conflicting attitudes and dealing with opioid stigma.Implication for PracticeClinicians should partner with patients with cancer, especially people of color, who may experience intersecting stigmas related to their cancer pain and opioid use, to best provide an individualized and culturally sensitive pain treatment plan.

Palliative Care Clinician Perspectives on Person-Centered End-of-Life Communication for Racially and Culturally Minoritized Persons with Cancer

“…Palliative care provision and outcomes for racially and culturally minoritized persons (e.g., Black and Native American people) with serious illness are substandard when compared to non-minoritized persons. For instance, care inequities for Black and Native American patients and their caregivers exist across the palliative care spectrum, including but not limited to poorer symptom management, disparate medically indicated treatments for pain (e.g., equitable opioid prescribing and monitoring practices) [ 6 , 7 , 8 , 9 , 10 , 11 ], discriminatory and biased clinician behaviors and communication [ 12 , 13 , 14 ], poor integration of patients’ spiritual and cultural values into care delivery [ 15 , 16 ], less high-quality evidence and documentation of advance care planning [ 17 , 18 , 19 ], and significant mistrust of the health system [ 20 , 21 ] that impacts patients’ decision making and relationships with clinicians. Such disparities lead to poorer clinical outcomes for patients (e.g., pain, goal discordant care) and caregivers (e.g., bereavement).…”