A Novel Approach to Elucidate Mechanisms for Disparity in Cancer Pain Outcomes

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DESCRIPTION (provided by applicant): Title: A Novel Approach to Elucidate Mechanisms for Disparity in Cancer Pain Outcomes This study responds to the broad challenge area (04) Clinical Research, and the specific challenge topic, 04- NR-102* Methods to Enhance Palliative Care and End-of-Life Research. Racial/ethnic disparities in palliative care outcomes are increasingly reported in the literature including inequalities in hospice enrollment, differential preference for high technology care at the end-of-life, and disparities in symptom management outcomes. Choice-Based Conjoint Analysis (CBC) is promising valuation technique grounded in the Random Utility Theory and mathematical psychology to understand what people value and what really drives them to choose one set of alternatives over another when faced with competing choices. While the technique is well established in the marketing arena and consumer research, the application of CBC in the healthcare field is relatively new, although there is growing interest in this methodology. CBC may enhance our understanding of the mechanisms underlying racial/ethnic disparities in palliative care outcomes. This potentially important application of CBC in studying sources of disparities has not been exploited in palliative care research. Using cancer pain treatment disparities as an exemplar, we propose to investigate the utility and predictive validity of CBC in identifying mechanisms underlying racial disparities in cancer pain treatment outcomes. Accumulating evidence suggests that African Americans are less likely to receive guideline recommended analgesia despite risk-adjustment and even among those insured at similar levels as non-minority individuals. The system and provider-level factors have not been able to fully explicate the mechanisms contributing to these disparities. Patient-level factors, including patients' attitudes and preferences towards pain treatment, that may also account for clinical disparities may hold the answer. Using CBC, this prospective study offers a unique conceptual, methodological, and analytical lens to understanding what value patients place in analgesic treatment for cancer pain and link this unique information to a comprehensive set of socio-demographic, illness and pain-related variables. Predictive ability of a measure is a critical determinant of its validity; the proposed study also assesses the predictive validity of CBC by investigating the relationship between stated preference (CBC utilities) and actual adherence to prescription analgesia for cancer pain. Moreover, the research carefully incorporates an analysis of racial disparities across aims to further understanding of clinical differences in cancer pain outcomes. The scientific approach identified in this study will lay the foundation for developing patient-centered interventions that incorporate patient preferences into complex medical decision-making in improving cancer pain outcomes and by extension outcomes in other symptom management settings. At University of Pennsylvania, we are well-positioned to quickly expand our research capacity and employee- base benefitting the science and the overall economy. In keeping with the American Recovery and Reinvestment Act, the current project will create 7 new jobs (1 full-time, 4 part-time, and 2 per-diem). Healthcare often involves making competing choices under risks and uncertainties. This research uses a novel technique, Choice-based Conjoint Analysis (CBC), to understand if African Americans and Whites with cancer pain use different mental trade-offs in arriving at pain treatment decisions; have differential preferences for cancer pain treatment; and how this may relate to their adherence to pain medications for cancer pain. CBC method has implications for generating knowledge about how subgroups of patients make decisions regarding choices such as symptom management, advanced care planning, hospice enrollment, or the use of technologically advanced end-of-life care. Findings will help identify targets sensitive to tailored, patient-centered interventions in improving equity in palliative care outcomes.