Adherence to Analgesics for Cancer Pain: A Comparative Study of African Americans and Whites Using an Electronic Monitoring Device.
Adherence to Analgesics for Cancer Pain: A Comparative Study of African Americans and Whites Using an Electronic Monitoring Device.
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DOI：
10.1016/j.jpain.2015.05.009
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Riegel B
中科院分区：
文献类型：
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作者：
Meghani SH;Thompson AM;Chittams J;Bruner DW;Riegel B
尽管非裔美国人在癌症疼痛结局方面的差异得到了很好的证明，但令人惊讶的是，在这一群体中，关于癌症疼痛坚持止痛的研究很少。我们使用药物事件监测系统[MEMS]比较了非裔美国人和白人在3个月的时间里对癌症相关疼痛的止痛依从性。患者(n=207)来自费城一家学术医学中心的肿瘤门诊[≥，18岁，被诊断为实体瘤或多发性骨髓瘤，伴有癌症相关疼痛，至少一种口服全天候止痛药处方]。非裔美国人报告的癌症疼痛明显更严重(P<；.001)，他们比白人更不可能服用长效阿片类药物(P<；.001)，并且更有可能有负的疼痛管理指数(P<；.001)。在整个MEMS剂量依从性方面，非裔美国人和白人之间有相当大的差异，即实际服用的处方剂量总数的百分比(53%对74%，P<；.001)。在子分析中，非裔美国人的止痛依从率从34%(弱阿片类药物)到63%(长效阿片类药物)不等。对止痛药依从性的独特预测因种族而异；收入水平、止痛药副作用和对分心提供者的恐惧预测非裔美国人的止痛药依从性，而不是白人。
Despite well-documented disparities in cancer pain outcomes among African Americans, surprisingly little research exists on adherence to analgesia for cancer pain in this group. We compared analgesic adherence for cancer-related pain over a 3-month period between African Americans and Whites using Medication Event Monitoring System [MEMS]. Patients (n=207) were recruited from outpatient medical oncology clinics of an academic medical center in Philadelphia [≥18 years of age, diagnosed with solid tumors or multiple myeloma, with cancer-related pain, and at least one prescription of oral around-the-clock analgesic (ATC)]. African Americans reported significantly greater cancer pain (P<.001), were less likely than Whites to have a prescription of long acting opioids (P<.001), and more likely to have a negative pain management index (P<.001). There were considerable differences between African Americans and Whites in the overall MEMS dose adherence, i.e., percentage of the total number of prescribed doses that were actually taken (53% vs. 74%, P<.001). On sub-analysis, analgesic adherence rates for African Americans ranged from 34% (for weak opioids) to 63% (for long acting opioids). Unique predictors of analgesic adherence varied by race; income levels, analgesic side-effects, and fear of distracting providers predicted analgesic adherence for African Americans but not for Whites.