The Influence of Patient Race and Activation on Pain Management in Advanced Lung Cancer: a Randomized Field Experiment.
| Title: | The Influence of Patient Race and Activation on Pain Management in Advanced Lung Cancer: a Randomized Field Experiment. |
|---|---|
| Authors: | Shields CG; Center for Cancer Research, Purdue University, West Lafayette, IN, USA.; Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA.; Human Development & Family Studies, Purdue University, West Lafayette, IN, USA.; Griggs JJ; Department of Internal Medicine, Hematology/ Oncology Division, and Health Management and Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA.; Department of Health Management & Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA.; Fiscella K; Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.; Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.; Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA.; Elias CM; Human Development & Family Studies, Purdue University, West Lafayette, IN, USA.; Christ SL; Human Development & Family Studies, Purdue University, West Lafayette, IN, USA.; Department of Statistics, Purdue University, West Lafayette, IN, USA.; Colbert J; Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, MI, USA.; Henry SG; Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.; Hoh BG; Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.; Hunte HER; School of Public Health, Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA.; Marshall M; Human Development & Family Studies, Purdue University, West Lafayette, IN, USA.; Mohile SG; James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.; Plumb S; Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.; Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.; James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.; Tejani MA; James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.; Venuti A; Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.; Epstein RM; Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu.; Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu.; Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu.; James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu.; Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu.; Family Medicine Research Programs, University of Rochester, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu. |
| Source: | Journal of general internal medicine [J Gen Intern Med] 2019 Mar; Vol. 34 (3), pp. 435-442. Date of Electronic Publication: 2019 Jan 10. |
| Publication Type: | Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural |
| Language: | English |
| Journal Info: | Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: Secaucus, NJ : Springer; Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986- |
| MeSH Terms: | Cancer Pain/*drug therapy ; Lung Neoplasms/*drug therapy ; Pain Management/*psychology ; Patient Participation/*psychology ; Physicians/*psychology ; Racial Groups/*psychology; Analgesics, Opioid/therapeutic use ; Pain Management/methods ; Patient Participation/methods ; Adult ; Aged ; Drug Prescriptions ; Female ; Humans ; Male ; Middle Aged |
| Abstract: | Background: Pain management racial disparities exist, yet it is unclear whether disparities exist in pain management in advanced cancer.; Objective: To examine the effect of race on physicians' pain assessment and treatment in advanced lung cancer and the moderating effect of patient activation.; Design: Randomized field experiment. Physicians consented to see two unannounced standardized patients (SPs) over 18 months. SPs portrayed 4 identical roles-a 62-year-old man with advanced lung cancer and uncontrolled pain-differing by race (black or white) and role (activated or typical). Activated SPs asked questions, interrupted when necessary, made requests, and expressed opinions.; Participants: Ninety-six primary care physicians (PCPs) and oncologists from small cities, and suburban and rural areas of New York, Indiana, and Michigan. Physicians' mean age was 52 years (SD = 27.17), 59% male, and 64% white.; Main Measures: Opioids prescribed (or not), total daily opioid doses (in oral morphine equivalents), guideline-concordant pain management, and pain assessment.; Key Results: SPs completed 181 covertly audio-recorded visits that had complete data for the model covariates. Physicians detected SPs in 15% of visits. Physicians prescribed opioids in 71% of visits; 38% received guideline-concordant doses. Neither race nor activation was associated with total opioid dose or guideline-concordant pain management, and there were no interaction effects (p > 0.05). Activation, but not race, was associated with improved pain assessment (ẞ, 0.46, 95% CI 0.18, 0.74). In post hoc analyses, oncologists (but not PCPs) were less likely to prescribe opioids to black SPs (OR 0.24, 95% CI 0.07, 0.81).; Conclusions: Neither race nor activation was associated with opioid prescribing; activation was associated with better pain assessment. In post hoc analyses, oncologists were less likely to prescribe opioids to black male SPs than white male SPs; PCPs had no racial disparities. In general, physicians may be under-prescribing opioids for cancer pain.; Trial Registration: NCT01501006. |
| References: | Cancer. 2011 May 1;117(9):1994-2003. (PMID: 21509777); Health Aff (Millwood). 2013 Feb;32(2):207-14. (PMID: 23381511); Health Serv Res. 2004 Aug;39(4 Pt 1):1005-26. (PMID: 15230939); JAMA. 1998 Jun 17;279(23):1877-82. (PMID: 9634258); Cancer. 2006 Sep 15;107(6):1313-20. (PMID: 16909424); Proc Natl Acad Sci U S A. 2016 Apr 19;113(16):4296-301. (PMID: 27044069); Pain Med. 2006 Mar-Apr;7(2):119-34. (PMID: 16634725); Psychooncology. 2014 Oct;23(10):1111-7. (PMID: 24687847); Pain Med. 2012 Feb;13(2):150-74. (PMID: 22239747); Patient Educ Couns. 2006 Sep;62(3):355-60. (PMID: 16860520); Ann N Y Acad Sci. 2010 Feb;1186:69-101. (PMID: 20201869); Psychooncology. 2016 Oct;25(10):1212-1221. (PMID: 27421683); Cancer. 2003 Jan 1;97(1 Suppl):311-7. (PMID: 12491494); Cancer. 2000 Apr 15;88(8):1929-38. (PMID: 10760771); J Pain Symptom Manage. 2007 Jan;33(1):24-31. (PMID: 17196904); J Pain. 2015 Sep;16(9):825-35. (PMID: 26080042); J Law Med Ethics. 2001 Spring;29(1):52-68. (PMID: 11521272); BMC Cancer. 2017 Aug 25;17(1):575. (PMID: 28841847); Pain Med. 2013 May;14(5):667-75. (PMID: 23631401); Pain. 2017 Jun;158(6):1091-1099. (PMID: 28267065); Cancer. 2010 Jul 15;116(14):3485-92. (PMID: 20564071); J Clin Oncol. 2016 Jul 1;34(19):2265-70. (PMID: 27161968); Ann Intern Med. 1996 Mar 1;124(5):497-504. (PMID: 8602709); J Pain Res. 2018 Apr 12;11:753-761. (PMID: 29695927); Health Commun. 2013;28(7):740-6. (PMID: 23356451); J Pain Symptom Manage. 2014 Dec;48(6):1050-9. (PMID: 24747225); J Clin Oncol. 2012 Jun 1;30(16):1980-8. (PMID: 22508819); Patient Educ Couns. 2009 Dec;77(3):349-59. (PMID: 19819096) |
| Grant Information: | K23 DA043052 United States DA NIDA NIH HHS; K24 AG056589 United States AG NIA NIH HHS; R01 CA155376 United States CA NCI NIH HHS |
| Contributed Indexing: | Keywords: communication; doctor-patient relations; lung cancer; pain management; racial disparities |
| Molecular Sequence: | ClinicalTrials.gov NCT01501006 |
| Substance Nomenclature: | 0 (Analgesics, Opioid) |
| Entry Date(s): | Date Created: 20190112 Date Completed: 20200813 Latest Revision: 20240922 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC6420510 |
| DOI: | 10.1007/s11606-018-4785-z |
| PMID: | 30632104 |
| Database: | MEDLINE |
Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural