Psycho-sociocultural factors influencing cancer pain management in elderly adults

描述(申请人)：流行病学证据表明，老年少数族裔成年人不太可能记录他们的癌症疼痛，他们的癌症疼痛被误诊和治疗不足的风险增加，报告的疼痛缓解或止痛治疗较少。该项目提出了两个阶段，描述性调查和教育疼痛管理干预，以评估这种差异是否受到已确定的社会、文化或心理结构的影响。第一阶段(描述性)的主要目标是阐明现有的社会、文化和心理来源，这些来源可能影响被诊断患有肺癌、结肠癌、乳腺癌或前列腺癌的老年黑人和白人的癌症疼痛体验、对癌症疼痛护理和管理的满意度。支持这一目标的目的是：1)评估老年黑人和白人癌症患者在社会(歧视、社会经济地位)、文化(文化传统、民族认同)和心理(抑郁、医生不信任、症状痛苦)变量上的差异，并确定这些因素是否可以作为解释不同健康结果的潜在中介因素；2)确定已发现的心理社会因素和文化因素之间的关系；以及3)评估拟议的理论模型在解释老年癌症患者种族群体内和种族之间已确定的健康结果变量的个体差异方面的有效性。在第一阶段概念模型的指导下，第二阶段(干预)的目标是：1)确定在老年黑白癌症患者中开展癌症疼痛管理教育干预的可行性和可接受性，2)评估患者对该计划的反应和满意度，同时找出可能成为有效疼痛管理障碍的心理、社会和文化因素。到目前为止，我们还没有发现研究确定的心理社会和文化因素(例如，歧视、种族认同)对最佳癌症疼痛管理的影响的研究。此外，很少有干预措施旨在解决这些结构，因为它们与老年人的癌症疼痛护理和管理有关。研究这些因素将被证明在潜在地缩小差距和消除癌症疼痛护理和管理的障碍方面至关重要。

DESCRIPTION (from applicant): Epidemiological evidence shows that elderly minority adults are less likely to have their cancer pain recorded, are at an increased risk for the misdiagnosis and under-treatment of their cancer pain, and report less relief or analgesic treatment for their pain. This project proposes two phases, a descriptive survey and an educational pain management intervention, to assess if such disparities are influenced by identified social, cultural, or psychological constructs. The primary objective for phase I (descriptive) is to elucidate existing social, cultural, and psychological sources that may influence the experience of cancer pain, satisfaction with cancer pain care and management in elderly Blacks and Whites diagnosed with lung, colon, breast, or prostate cancer. The aims to support this objective are to: 1) assess whether elderly Black and White cancer patients differ in social (discrimination, SES), cultural (cultural heritage, ethnic identity), and psychological (depression, physician mistrust, symptom distress) variables, and to determine if these factors serve as potential mediators explaining differential health outcomes, 2) determine the relationship between identified psychosocial and cultural factors, and 3) assess the utility of a proposed theoretical model in explaining individual differences in identified health outcome variables both within and between race groups of elderly cancer patients. Guided by phase I's conceptual model, the objective for phase II (intervention) is to: 1) determine the feasibility and acceptability of a cancer pain management education intervention among elderly Black and White cancer patients, and 2) evaluate patients' reactions to and satisfaction with the program, while identifying potential psychological, social, and cultural constructs that present as barriers to effective pain management. To date, we have identified no studies that have examined the impact identified psychosocial and cultural factors (e.g., discrimination, ethnic identity) have on optimal cancer pain management. In addition, there are few interventions designed to address these constructs as they relate to cancer pain care and management among the elderly. Examining these factors will prove pivotal in potentially reducing disparities and eliminating barriers to cancer pain care and management.