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Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

From the Department of Symptom Research, Division of Internal Medicine, Department of Breast Medical Oncology, Department of Bioimmunotherapy, The University of Texas M.D. Anderson Cancer Center, Houston; Hematology-Oncology Section, Department of Medicine, Baylor College of Medicine, Houston, TX; Duke Divinity School, Duke University, Durham, NC; Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL; and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI

Address reprint requests to Karen O. Anderson, PhD, The University of Texas M.D. Anderson Cancer Center, Department of Symptom Research, 1100 Holcombe Blvd, Box 221, Houston, TX 77030; e-mail: koanderso{at}mdanderson.org

PURPOSE: Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients.

PATIENTS AND METHODS: Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments.

RESULTS: Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments.

CONCLUSION: Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.

Supported by the United States Army Medical Research and Materiel Command under DAMD17-94-J-4233 and by Public Health Service grant Nos. CA26582, CA64766, and CA85228 from the National Cancer Institute.

Presented in part at the 22nd Annual Scientific Meeting of the American Pain Society, March 20-23, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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