CANCER PAIN RELIEF SKILLS FOR MINORITY OUTPATIENTS

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The majority of ambulatory outpatients with metastatic cancer have pain and one-third have pain so severe that it restricts their ability to function. Outpatients with cancer from underserved populations are at especially high risk for poor pain management; these patient are three times as likely, by World Health Organization standards, to be prescribed analgesics too weak to control their pain. Our data indicate that over 60% of African-American and over 80% of Hispanic outpatients with cancer- related pain receive less than adequate analgesic prescriptions. As with non-minority patients, these patients often have exaggerated concerns that limit their reporting of pain and their use of analgesics. They also face additional barriers to pain management in terms of limited contact with providers, difficulty paying for medications, and greater health care professional concern about addiction. In our studies, more than twice the number of patients from these groups report that they need more pain medication and need more information about pain management than do non- minority patients. Educating these patients about pain and its management and training them with the skills they need to obtain pain relief should improve their pain control and increase their ability to function. This project will assess the needs of minority lower socio-economic cancer outpatients for information and skills needed to manage pain, develop multi-media education and training materials that are linguistically and culturally appropriate for Hispanic and African American populations. To accomplish these tasks we have (a) formed a network of three urban public hospital outpatient clinics that treat these patients and (b) established a multi-disciplinary team of investigators and consultants with the expertise necessary to meet project goals. We will evaluate the effectiveness of this training program in a randomized, controlled clinical trial for African American and Hispanic outpatients with metastatic breast or prostate cancer and disease-related pain. If this program is effective, it can be easily be introduced by other care centers where these patients are treated.