Open Access Article
Article

Unequal Quality of Cancer Pain Management: Disparity in Perceived Control and Proposed Solutions

Jeanette A. McNeill

Janice Reynolds

Margaret L. Ney

perceptions, healthcare disparities, pain management
ONF 2007, 34(6), 1121-1128. DOI: 10.1188/07.ONF.1121-1128

Purpose/Objectives: To examine poverty-related and racial and ethnic disparity in cancer pain management.

Data Sources: Published articles, conference proceedings, testimony, and clinical case studies.

Data Synthesis: Disparity in the quality of cancer pain management exists resulting from interactions among patient, provider, and environmental factors. Irrespective of etiology, disparity results in inadequate management of cancer pain for vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care. Inadequate symptom management affects cancer treatment tolerance, exacerbating disparity in treatment outcomes and affecting end-of-life care.

Conclusions: Evidence-based solutions include a systems approach, quality-improvement and quality-assurance processes that expose disparities and enforce evidence-based treatment per national guidelines, and statewide comprehensive cancer planning to target pain management outcomes.

Implications for Nursing: Oncology nurses and interdisciplinary teams must be aware of disparities in cancer pain management for vulnerable groups, intervene to empower patients through customized educational approaches, and simultaneously implement systemwide strategies to ensure effective pain management and targeted monitoring for high-risk patients.

Jump to a section

    References

    Agency for Healthcare Research and Quality. (2004). National healthcare disparities report [Pub. No. 05-0014]. Rockville, MD: Author.
    American Pain Society. (2004). Racial and ethnic identifiers in pain management: The importance to research, clinical practice and public health policy. Retrieved March 13, 2007, from http://www.ampainsoc.org/pub/bulletin/spr05/sig1.htm
    Anderson, K.O., Mendoza, T.R., Valero, V., Richman, S.P., Russell, C., Hurley, J., et al. (2000). Minority cancer patients and their providers: Pain management attitudes and practice. Cancer, 88, 1929-1938.
    Bonham, V. (2001). Race, ethnicity and pain treatment: Striving to understand the causes and solutions to the disparities in pain treatment. Journal of Law, Medicine and Ethics, 29, 52-68.
    Cintron, A., & Morrison, R.S. (2006). Pain and ethnicity in the United States: A systematic review. Journal of Palliative Medicine, 9, 1454-1471.
    Cleeland, C., Gonin, R., Hatfield, A., Edmonson, J., Blum, R., Stewart, J., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330, 592-596.
    Dahl, J. (2004). Pain: Impediments and suggestions for solutions. Journal of the National Cancer Institute Monographs, 32, 124-126.
    Eversley, R., Estrin, D., Dibble, S., Wardlaw, L., Pedrosa, M., & Favila-Penney, W. (2005). Post-treatment symptoms among ethnic minority breast cancer survivors. Oncology Nursing Forum, 32, 250-256.
    Fiscella, K., Franks, P., Gold, M.R., & Clancy, C.M. (2000). Inequality in quality: Addressing socioeconomic, racial and ethnic disparities in health care. JAMA, 283, 2579-2584.
    Freeman, H. (2004). Poverty, culture, and social injustice: Determinants of cancer disparities. CA: A Cancer Journal for Clinicians, 54, 72-77.
    Garson, A. (2006). The uninsured: Problems, solutions and the role of academic medicine [health policy]. Academic Medicine, 81, 798-801.
    Gibson, R. (2001). Palliative care for the poor and disenfranchised: A view from the Robert Wood Johnson Foundation. Journal of the Royal Society of Medicine, 94, 486-489.
    Glassman, P. (2007). Health literacy. National Network of Libraries of Medicine. Retrieved January 28, 2007, from http://nnlm.gov/outreach/consumer/hlthlit.html
    Green, C.R., Anderson, K.O., Baker, T.A., Campbell, L.C., Decker, S., Fillingim, R.B., et al. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4, 227-294.
    Hall, S. (2005, February 20). Pain goes untreated for many minorities. The Detroit News. Retrieved January 15, 2007, from http://www.detnews.com/2005/specialreport/0502/20/A01-94927.htm
    Hatton, D.C. (2001). Homeless women's access to health services: A study of social networks and managed care in the US. Women and Health, 33, 149-162.
    Headen, A., & Masia, N. (2005). Exploring the potential link between Medicaid access restrictions, physician location and health disparities. American Journal of Managed Care, 11(Suppl.), SP21-SP26.
    Herr, K., Titler, M.G., Schilling, M.L., March, J.L., Xie, X., Ardery, G., et al. (2004). Evidence-based assessment of acute pain in older adults: Current nursing practices and perceived barriers. Clinical Journal of Pain, 20, 331-340.
    Hutchison, L., Hawes, C., & Williams, L. (2005). Access to quality health services in rural areas—Long-term care. In L. Gamm, & L. Hutchison (Eds.) Rural healthy people 2010. Retrieved March 9, 2007, from http://www.srph.tamhsc.edu/centers/rhp2010/Volume_3/Vol3Ch1OV.htm
    Institute of Medicine. (2003). Unequal treatment. Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press.
    Kapo, J., MacMoran, H., & Casarett, D. (2005). Lost to follow up: Ethnic disparities in continuity of hospice care at the end of life. Journal of Palliative Medicine, 8, 603-608.
    Keefe, F., Ahles, T., Sutton, L., Dalton, J., Baucom, D., Pope, M., et al. (2005). Partner-guided cancer pain management at the end of life: A preliminary study. Journal of Pain and Symptom Management, 29, 263-272.
    Kushel, M.B., & Miaskowski, C. (2006). End-of-life care for homeless patients. JAMA, 296, 2959-2966.
    Lebovits, A. (2005). The ethical implications of racial disparities in pain: Are some of us more equal? Pain Medicine, 6(1), 3-4.
    McNeill, J.A., Sherwood, G.D., & Starck, P.L. (2004). The hidden error of mismanaged pain: A systems approach. Journal of Pain and Symptom Management, 28, 47-58.
    Miettinen, T.T., Tilvis, R.S., Karppi, P., & Arve, S. (1998). Why is the pain relief of dying patients often unsuccessful? The relatives' perspectives. Palliative Medicine, 12, 429-435.
    Morrison, R., Wallenstein, S., Natale, D., Senzel, R., & Huang, L. (2000). "We don't carry that"—Failure of pharmacies in predominately nonwhite neighborhoods to stock opioid analgesics. New England Journal of Medicine, 343, 1023-1026.
    Nesbit, S., Baluss, M., Colon, Y., Farkas, H., Gloth, F., Kaiser, K., et al. (2004). Pain management. The Maryland Comprehensive Cancer Control Plan. Retrieved January 21, 2007, from http://fha.state.md.us/cancer/cancerplan/plan/Ch14_Pain_Management.pdf
    Office of Minority Health. (n.d.). National standards for culturally and linguistically appropriate services for all patients. Retrieved March 19, 2007, from http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15
    Passik, S.D., & Kirsh, K.L. (2005). Managing pain in patients with aberrant drug taking behaviors. Journal of Supportive Oncology, 3, 83-86.
    Strassels, S., Blough, D., Hazlet, T., Veenstra, D., & Sullivan, S. (2006). Pain, demographics, and clinical characteristics in persons who received hospice care in the United States. Journal of Pain and Symptom Management, 32, 519-531.
    Tait, R.C., & Chibnall, J.T. (2005). Racial and ethnic disparities in the evaluation and treatment of pain: Psychological perspectives. Professional Psychology: Treatment and Practice, 36, 595-601.
    University of Michigan News Service. (2005, July 5). The rich die differently from you and me, study shows. Retrieved January 15, 2007, from http://www.umich.edu/news/index.html?Releases/2005/Jul05/r070505b
    Vallerand, A., Hasenau, S., Templin, T., & Collins-Bohler, D. (2005). Disparities between black and white patients with cancer pain: The effect of perception of control over pain. Pain Medicine, 6, 242-250.
    Ward, E., Jemal, A., Cokkinides, V., Singh, G., Cardinex, C., Ghafoor, C., et al. (2004). Cancer disparities by race/ethnicity, and socioeconomic status. CA: A Cancer Journal for Clinicians, 54, 78-93.