Adherence in African Americans Being Treated for Cancer Pain

描述(由申请人提供)：非洲裔美国人经历了不成比例的癌症疼痛负担，遭受更糟糕的治疗结果，总体上对止痛药的依从性很差。不幸的是，过去关于疼痛的研究没有充分探索在经济上不同的非裔美国人群体中，癌症疼痛缓解和治疗坚持的重要因素。如果我们要更好地理解为什么当有足够的治疗可用时，他们得到的疼痛缓解不充分，了解个人不坚持疼痛治疗的原因是至关重要的。拟议的应用程序通过探索个人的背景--围绕着他们并影响他们的行为的社会网络和社区--超越了之前对遵守的理解。这种对社会背景因素的审查需要一种混合的方法和多层次的方法来探索阿片类药物依从性的“什么”和“如何”。在社会生态模型的框架下，这项研究的目的是考察个人(症状包括疼痛和抑郁、疼痛信念、教育和性别)、人际(宗教和社会支持)和邻里因素(社会经济措施、种族隔离和与毒品有关的犯罪)对接受癌症疼痛治疗的非裔美国人“全天候”阿片类药物依从性的影响。将使用并行混合方法设计方法，包括定量和定性链。定量部分将提供影响阿片类药物依从性的因素的信息，定性部分将提供这些因素如何影响依从性的丰富描述。在执行这项研究的同时，将在埃默里大学进行全面的培训和职业指导计划，在症状结果、疼痛差异、服药依从性和健康社会人口结果的社区因素方面的专家的指导下进行。候选人的培训目标包括：1)发展混合方法研究方面的专门知识，重点是治疗癌症疼痛的少数样本；2)获得地理空间分析和统计的方法学技能，以便更好地了解不遵守阿片类药物的差异的来源；以及3) 培养技能，为研究轨迹中的下一步定位。该项目的目标是提高非裔美国人对止痛药依从性的了解。长期目标是确定有效的机制来改善癌症疼痛的缓解，特别是对于那些癌症负担最重的人，非裔美国人。这笔培训赠款将为候选人成为一名成功的独立研究人员做好准备，提供初步信息，通过治疗/评估建议和/或患者和社区干预改善疼痛管理，最终改善患有癌症疼痛的非裔美国人的疼痛管理。

DESCRIPTION (provided by applicant): 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.