Adherence in African Americans Being Treated for Cancer Pain

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African Americans experience a disproportionate burden of cancer pain, suffer worse treatment outcomes, and have overall poor adherence to pain medication. Unfortunately, past research on pain has not fully explored factors important to cancer pain relief and treatment adherence in an economically diverse group of African Americans. Knowledge of the reasons why individuals do not adhere to pain treatment is essential if we are to better understand why they receive inadequate pain relief when adequate treatments are available. The proposed application moves beyond previous understanding of adherence by exploring the context of individuals - the social network and neighborhood that surround them and influence their behavior. This examination of social contextual factors requires a mixed method multilevel approach to explore the "what" and "how" of opiate adherence. Framed in a social ecological model, the aims of this study are to examine the influence of individual (symptom profile including pain and depression, pain beliefs, education, and gender) interpersonal (religious and social support), and neighborhood factors (socioeconomic measures, segregation, and drug related crime) on "around the clock" opiate adherence in African Americans being treated for cancer pain. A parallel mixed method design approach will be used that includes a quantitative and qualitative strand. The quantitative strand will provide information on what factors influence opiate adherence and the qualitative strand will provide a rich description of how these factors affect adherence. Along with the execution of this research, a comprehensive training and career mentoring plan will be carried out at Emory University under the mentorship of experts in symptom outcomes, pain disparities, medication adherence, and community factors of sociodemographic outcomes of health. The candidate's training goals include: 1) develop expertise in mixed- method research focusing on a minority sample being treated for cancer pain; 2) acquire methodological skills in geospatial analysis and statistics in order to better understand sources of disparities in non-adherence to opiates; and 3) build skills to position for next steps in the research trajectory. The goal of this project is to enhance understanding of pain medication adherence in African Americans. The long-range goal is to identify effective mechanisms to improve cancer pain relief, especially for those suffering the highest burden of cancer, African Americans. This training grant will prepare the candidate to be a successful independent researcher with preliminary information to improve pain management through treatment/assessment recommendations and/or patient and community interventions to ultimately improve pain management in African Americans with cancer pain.