How racial bias affects cancer pain control

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Race and other factors could play in a role in the pain control cancer patients receive, research finds.

For example, a 62-year-old with stage IV lung cancer that has spread to his bones, causing unspeakable pain, is trying to convince his physician to prescribe pain medicine. What happens next?

In addition to race, the response could also depend on whether the physician is a primary care provider or an oncologist.

“We expected to find direct racial differences, but we only found racial differences with the oncologists.”

Historically, black patients report greater pain, mostly due to under-treatment, and are less likely to receive adequate pain management, says Cleveland Shields, a professor in the human development and family studies department at Purdue University, who specializes in physician-patient communication, and health disparities due to race, poverty, and geography.

“We know that race affects the quality of care that patients receive,” says Ronald Epstein of the University of Rochester School of Medicine. “Our study clarifies when, how, and under what circumstances racial bias enters into the picture. Our findings will help train the next generation of physicians to be more aware of their biases and provide more equitable care.”

“Racial disparities in pain control are well-documented. There is plenty of evidence that black patients receive less adequate pain management than white patients,” says Shields.

To conduct the five-year study, researchers enlisted and trained standardized patients or “secret shoppers” who visited 96 primary care physicians and oncologists in urban and rural settings in Indiana, Michigan, and New York. The physicians didn’t know what topics or aspects of patient care were the focus of the study.

Researchers assigned either two black patients or two white patients to a physician’s office. Four or more months separated the visits.

Half of the standardized patients received training in how to interact, ask questions, and express opinions with the physicians. The other half received no training. The trained patients saw an improvement in the physicians’ communication and interaction.

“When you have improved communication about pain control, it increases appropriate prescribing,” Shields says. “We expected to find direct racial differences, but we only found racial differences with the oncologists.”

Additional coauthors are from Purdue, the University of Rochester School of Medicine, the University of Michigan School of Medicine, the University of California Davis School of Medicine, and West Virginia University.

The National Cancer Institute funded the work, which appears in the Journal of General Internal Medicine.

Source: Purdue University