Department of Quantitative Health Sciences; Graduate School of Biomedical Sciences, Clinical and Population Health Research Program
Geriatrics | Health Services Administration | Health Services Research | Neoplasms | Pain Management | Pathological Conditions, Signs and Symptoms | Psychological Phenomena and Processes | Race and Ethnicity | Therapeutics | Translational Medical Research
Background: Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission.
Methods: Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies.
Results: Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97-0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86-0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97-0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96-0.99).
Conclusion: Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored.
UMCCTS funding, cancer, nursing homes, pain, pain management, race
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DOI of Published Version
J Pain Res. 2018 Apr 12;11:753-761. doi: 10.2147/JPR.S158128. eCollection 2018. Link to article on publisher's site
Journal of pain research
Mack D, Hunnicutt JN, Jesdale WM, Lapane KL. (2018). Non-Hispanic Black-White disparities in pain and pain management among newly admitted nursing home residents with cancer. UMass Center for Clinical and Translational Science Supported Publications. https://doi.org/10.2147/JPR.S158128. Retrieved from https://escholarship.umassmed.edu/umccts_pubs/137
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License
Geriatrics Commons, Health Services Administration Commons, Health Services Research Commons, Neoplasms Commons, Pain Management Commons, Pathological Conditions, Signs and Symptoms Commons, Psychological Phenomena and Processes Commons, Race and Ethnicity Commons, Therapeutics Commons, Translational Medical Research Commons