Racial and Ethnic Variation in Pain Following Inpatient Palliative Care Consultations

Abstract

Studies have documented high levels of pain in hospitalized individuals at the end of life, with minorities reporting higher levels of pain than whites. In response, inpatient palliative care (IPC) teams have grown rapidly to improve care of seriously ill individuals. Although research indicates that IPC teams effectively reduce and maintain control of pain, racial and ethnic differences in pain following IPC consultation remain unclear. This study investigated racial and ethnic pain differences after an IPC intervention in 385 seriously ill white, black, and Latino individuals aged 65 and older. Using the 11-point Numeric Rating Scale for pain, individuals were asked to rate their pain intensity at four points during hospitalization (before IPC consultation, 2 and 24 hours after the consultation, and at hospital discharge). Results indicate that whites (F1.657, 173.998 = 16.528, P < .001), blacks (F1.800, 95.410 = 7.103, P = .002), and Latinos (F1.388, 73.584 = 10.902, P < .001) all experienced significant reductions in pain after the intervention. Adjusted multivariate models testing between-group racial and ethnic differences revealed that Latinos were 62% more likely than whites to report experiencing pain at hospital discharge (relative risk = 0.38, 95% confidence interval = 0.15-0.97). Regardless of race or ethnicity, IPC effectively reduces and controls pain after consultation. Despite pain decreases, Latinos remain more likely than whites to report pain at follow-up. Further research is needed to determine the mechanisms in operation and to better understand and address the needs of this population.

Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients

“…There are a few other studies which have looked at change in symptoms within 24 h of palliative care consultation and shown improvement [8,14,18], but most studies have looked at improvement over a longer time frame, ranging between 3 days after consultation and the time of discharge [9][10][11][12][13]15,16]. This finding is particularly relevant for a few reasons.…”

“…The results may not be generalizable to institutions where similar palliative care services are not available or where the patient population is different. Our cohort was racially homogenous and there is some evidence that pain control after palliative care consultation may differ by race [18]. We did not have a control group and therefore cannot draw conclusions regarding a causal relationship between palliative care consultation and improvement in symptom burden.…”

“…It is difficult to compare the details of our findings to the existing literature base because of the degree in variation across studies of palliative care consultation for symptom management in scale used to measure symptoms, how improvement is defined and the time frame over which change in symptom burden is measured. Many studies of inpatient palliative care for symptom management have represented symptom burden in terms of a measure of central tendency (mean or median) in scales including between 4 and 11 points [9,10,12,15,17,18]. Because of the prevalence in any cohort of patients with either no or mild symptom intensity, the central tendency measurement is often below the level that would be considered clinically significant, making it more difficult to contextualize and judge the clinical significance of improvements even when the changes are statistically significant.…”

“…Prior studies of impact of inpatient palliative care consultation on symptom burden have included few or no gynecologic cancer patients [8][9][10][11][12][13][14][15][16][17][18]. Though they have varied widely in patient population, scale used to measure symptoms, outcome definitions and time frame over which changes in symptoms are measured, these studies have established an association between inpatient palliative care consultation and improved symptom burden.…”

Ethnic Differences Identified by Pain Sensitivity Questionnaire Correlate With Clinical Pain Responses

“…Lu et al 13 found the opposite to be true when studying children; NHWs displayed more pain sensitivity as compared with AAs. In addition, Laguna et al 14 and Ford et al 15 found no significant difference between ethnicities in baseline pain ratings prior to palliative care consultation in populations of patients with dementia or in the hospital. Furthermore, no difference was found in prevalence of headache/migraine among ethnicities in a previous study.…”