Disparities in Cancer Pain Assessment and Management among Ethnic Minorities

Poor pain control impairs quality of life and functionality. Despite the increased knowledge of pain mechanisms, existing guidelines and improved methods to manage cancer pain, it remains inadequately treated, especially among ethnic minorities. A number of factors play role in the existing cancer pain management disparity: (a) language barriers between patients and providers; (b) providers' limited knowledge of cultural behaviors and pain expression; (c) providers' inadequate cultural competence awareness training; (d) providers' bias and stereotyping in clinical communication and decision-making; (e) reluctance to prescribe opioids; insufficient training and continuing education in cultural competence and chronic pain treatment; (f) underutilization of referrals to pain specialists; (g) poor provider to patient education and communication with ethnic minorities; and (h) high time pressure, cognitive complexity, and pressures for cost-containment (Stockler & Wilcken, 2012; Im, et al., 2009). Despite the accepted optimal pharmacotherapy, there is no systematic approach in pharmacotherapeutic cancer pain treatment. The purpose of this project is to develop a pain assessment and management algorithm and guide for providers treating cancer patient's pain that provides an approach to pain assessment and management that is culturally sensitive and effective when considering pain treatment with ethnically diverse patients. This project's objectives are 1) identify existing barriers to pain management among ethnic groups at Mountain State Tumor Institute (MSTI) and St. Luke's inpatient Oncology (SL) in Boise, Idaho; 2) identify existing guidelines for pain assessment and management at the clinical sites and in the literature;3) develop an educational presentation with a downloadable educational model for nurses, and 4) present the educational session during the MSTI and SL staff meeting; 5) disseminate the presentation and the model through the St. Luke's online SumTotal Learning Center and Doctors of Nursing Practice Organization website. The implementation phase included a literature review of pain assessment and management for minorities; palliative care experts' were consulted. A number of cultural barriers in pain management at clinical sites were identified. One of the major obstacles for providing a culturally appropriate cancer pain assessment was the lack of the current evidence targeting ethnic minorities. Salient points of pain assessment and management for ethnic minorities were gathered, outlined, and approved by the content experts. The project was presented and disseminated as above. The purpose of the project was fulfilled and evaluated. Staffs' knowledge and competence in assessing and managing cancer pain of culturally diverse patient populations have significantly increased based on the post educational session evaluation. The message of reducing the burden of cancer pain and the disparities in healthcare delivery for ethnic minorities was recognized as an essential part in everyday practice. Future project development recommendations would include: 1) create a mandatory continuing education module "Cultural Pain Assessment & Management" for clinicians in various primary care settings; 2) create a continuing patient education module about the various Pain Assessment Tools, Pain Assessment & Management paths and algorithms; 3) research on patient perceptions of the various pain models; and 4) propose a culturally sensitive pain assessment & management protocol and/or guideline to be further maintained based on the latest evidence-based data & recommendations.