Racial Differences in Pain Management for Patients Receiving Hospice Care

Booker, Staja Q.; Herr, Keela; Garvan, Cynthia Wilson

doi:10.1188/20.onf.228-240

Cited by 7 publications

(28 citation statements)

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“…Two studies found that Black and African American patients were significantly less likely to receive an initial assessment for pain on admission, compared to White and Caucasian patients [ 91 , 99 ]; and one reported that only 25% of African American patients and 29% of Hispanic patients indicated their doctor or nurse had used a pain scale for assessment [ 89 ]. One study reported on issues of the timing of pain management.…”

Section: Resultsmentioning

confidence: 99%

“…Three longitudinal studies examined differences in medication use as part of multifaceted palliative care research interventions: One showed no significant differences for people of different racial groups after the intervention [ 95 ]; another found no differences in pain medications given to people by racial or ethnic group [ 91 ], and another found African American patients were significantly less likely to receive opioid medications compared to White patients [ 115 ].…”

Section: Resultsmentioning

confidence: 99%

“…For the mixed methods synthesis: Those from ethnically diverse backgrounds in the USA may not receive the same level of pain relief from their treatment [ 83 , 84 , 90 , 92 ]. Black and Hispanic people in the USA may be less likely to receive adequate pain assessment [ 89 , 91 , 99 ]. Patients from all racial and ethnic groups had fears about side effects [ 88 , 89 , 96 , 102 , 106 , 108 , 128 , 129 , 131 ], but people from ethnically diverse groups in the USA and Australia were more likely to express fears of addiction or tolerance [ 89 , 96 , 102 , 106 , 108 , 131 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two USA studies showed that significantly fewer Black and African American patients received an initial pain assessment [ 91 , 99 ], and a further paper found that a pain scale had only been used for 25% of African American patients and 29% of Hispanic patients [ 89 ]. The lack of standardised measurement, potentially means that Hispanic, Black and African American patients’ pain is not being recognised initially, and appropriate referrals to palliative care are not being made.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of ‘very high’ Human Development Index English-speaking countries

et al. 2022

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Background Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. Methods Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. Results Eighteen papers were included in the primary outcome analysis. Three papers were rated ‘High’ weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. Conclusions There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients’ pain management concerns. Trial registration PROSPERO-CRD42020167890.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of ‘very high’ Human Development Index English-speaking countries

et al. 2022

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“…However, the results from the various studies included in our analysis were heterogeneous, with some studies identifying disparities 23,[26][27][28]31,32 whereas others did not identify any disparities. [20][21][22]29,33 Among the things we believe to have driven this finding are differences in how comparison groups were defined. For example, some studies found disparities with one minority group, while others found disparities among two or more minority groups.…”

Section: Discussionmentioning

confidence: 96%

A scoping review on the relationship between race/ethnicity and the receipt of supportive care medications during cancer treatment: Implications for the clinical pharmacist

Awunti

DeRemer

Rogers

et al. 2022

J Am Coll Clin Pharm

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There is surmounting levels of evidence on the health disparities within cancer treatment in the United States (US). Most of the research focused on cancer specific factors including anticancer incidence, screening, treatment and follow‐up, and clinical outcomes such as overall survival (OS). Less is known about the disparities present with supportive care medication use in cancer patients. Supportive care utilization during cancer treatment has been linked to improved quality of life (QoL) and OS among patients. The goal of this scoping review is to summarize findings of current literature on the relationship between race and ethnicity and the receipt of supportive care medications during cancer treatment for pain and chemotherapy‐induced nausea and vomiting (CINV). This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA‐ScR) guidelines. Our literature search included quantitative studies, qualitative studies, and grey literature written in the English language with clinically relevant outcomes pertaining to pain and CINV management in cancer treatment published from 2001 to 2021. Articles that met the predefined inclusion criteria were considered for inclusion in the analysis. The initial search yielded 308 studies. Following deduplication and screening, 14 studies met the predefined inclusion criteria, with majority of the studies being quantitative studies (n = 13). Collectively, results were mixed results regarding the presence of racial disparities for supportive care medication use. Half of the studies (n = 7) supported this finding whereas, the other half (n = 7) did not identify any racial disparities. In our review, multiple studies illustrate the existence of disparities in the use of supportive care medications in some cancer types. Clinical pharmacists should strive to eliminate supportive medication use disparities as part of a multidisciplinary team. In order to develop strategies to prevent supportive care medication use disparities in this population, further research and analysis of external factors that influence them are needed.

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Ethnic Inequalities in Palliative Care Prescribing – A Rapid Systematic Review

Kunonga,

Johnson,

Din

et al. 2024

Preprint

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Context: Effective palliative care involves managing the many symptoms commonly experienced towards the end-of-life. Appropriate prescribing is key to this care, and ethnic inequalities may lead to unequal treatment and poorer outcomes for minority groups. Understanding these disparities is critical to ensuring equitable care. Objectives: To investigate ethnic inequalities in palliative care prescribing amongst adults residing in high-income countries. Methods: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023476977. We conducted searches across three electronic databases (MEDLINE, Embase, and CINAHL) from January 2000 to November 2023. Screening, data extraction and quality assessment were conducted independently by two reviewers. Quality was assessed using various JBI Critical Appraisal tools. Due to the heterogeneity of included studies, a narrative review was undertaken without a meta-analysis. Results: Out of 7880 references identified, 10 studies met the inclusion criteria, all conducted in the United States. Overall, five studies were deemed to be high quality and five were fair quality. The studies highlighted ethnic disparities in palliative care prescribing. Minority populations were less likely to receive pain management medications, particularly opioids, compared to non-Hispanic whites. Increased age, female gender, lower socioeconomic status, and place of residence were also related to differences in prescribing practices. Conclusions: This rapid systematic review suggests that there are ethnic inequalities in palliative care symptom management prescribing, highlighting a possible gap in care for ethnic minority patients. Research beyond the USA is needed to understand if there are international disparities in palliative care prescribing.

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Racial Differences in Pain Management for Patients Receiving Hospice Care

Cited by 7 publications

References 50 publications

Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of ‘very high’ Human Development Index English-speaking countries

Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of ‘very high’ Human Development Index English-speaking countries

A scoping review on the relationship between race/ethnicity and the receipt of supportive care medications during cancer treatment: Implications for the clinical pharmacist

Ethnic Inequalities in Palliative Care Prescribing – A Rapid Systematic Review

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