African Americans, Whites, Differ in Decision-making Regarding Preferences for Cancer Pain Treatment

BALTIMORE, Md.—A pilot study designed to understand how preferences for analgesic treatment for cancer pain vary between African Americans and whites found that each group may employ different heuristics in making decisions, despite having similar levels of education and health literacy. This was the result of a study conducted by Salimah H. Meghani, PhD, of the University of Pennsylvania, Philadelphia, to determine whether patient-level factors existed with respect to racial/ethnic disparities in the treatment of pain.

A sample of 35 African Americans and 41 whites were recruited from an outpatient medical oncology clinic in the mid-Atlantic region. Participants, all older than 18 years of age, had been diagnosed with a solid tumor and were experiencing cancer-related pain within the week prior to the survey. Using Choice-based Conjoint Analysis, analgesic preference was elicited using a computer-based survey. Characteristics of pain treatment were assessed using the Brief Pain Inventory, Medication Side Effect Checklist, and the Barriers Questionnaire.

Median age of the participants was 55.5 years. Analysis of the data found African Americans and whites did not differ on age, gender, education, insurance, or health literacy. African Americans did report higher pain than whites (5.2 vs 4.5; P=0.04) as well as lower relief with analgesics (3.9 vs 2.8, respectively; P=0.015). A trend for African Americans to report more side effects, 24.7 vs 19.2 (P=0.076), and barriers to using analgesics, 80.0 vs 71.0 (P=0.067), was also observed.

Concern for various analgesic attributes, including type, percent of relief achieved, types of side effects, severity, or out-of-pocket costs did not differ between African Americans and whites. African Americans, however, rated being “strong” and not talking about pain as being more important in making decisions about treatment than did whites (44.3 vs 33.5; P=0.033), and also mentioned more barriers to communication (13.6 vs 10.9; P=0.046), despite the groups not differing in education or health literacy.

Future research should identify specific domains of communication that may be amenable to tailored interventions that minimize racial and ethnic disparities in pain treatment, Dr. Meghani concluded during the American Pain Society's 29th Annual Scientific Meeting.