- Email: [email protected]
Last Among Equals? Identifying and Managing Pain Disparities in Multicultural Populations (TH306)
Vol. 45 No. 2 February 2013
Schedule With Abstracts
developed pediatric palliative medical homes that seek to meet the needs of children and their families by delivering palliative care in a primary care context, thus bridging the gap between inpatient palliative care programs and hospice services. Lessons learned and challenges experienced will be shared with the audience. Levels of service and types of patients served as well as selection criteria will be described. Presenters will share case scenarios to demonstrate trajectories of patients through care settings, from inpatient to clinic to home. Finally, through questions and comments from participants, caveats and innovative ideas will be elicited and explored.
Last Among Equals? Identifying and Managing Pain Disparities in Multicultural Populations (TH306) Vyjeyanthi Periyakoil, MD, Stanford University, Palo Alto, CA. (Periyakoil had no relevant financial relationships to disclose.) Objectives 1. Review current data related to disparities in pain care and identify three common reasons underlying pain care disparities. 2. Use immersive exercises and case studies to identify implicit biases and unconscious stereotypes and how these may influence the behavior of clinicians. 3. Identify simple strategies to improve pain care for your patients from multicultural backgrounds. The influence of race and ethnicity on access to health care is a major issue in the United States. Consistent with the Institute of Medicine’s report on healthcare disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (e.g., postoperative, emergency room) and across all types of pain (e.g., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/healthcare provider communication, attitudes), healthcare provider (e.g., decision making), and healthcare system (e.g., access to pain medication) factors. The way that pain is perceived and the way it is dealt with is largely influenced by the ethnocultural background of the individuals and families experiencing the pain. Significant racial- and ethnic-based differences in the pain care
335
experience have been described. A recent study showed that racial and ethnic minorities undergoing hip and knee arthroplasty appear to have worse patient-perceived outcomes (well-being, pain, and function) when compared to whites, with this discrepancy being most pronounced for African Americans. Another large study examining ethnic differences in pain reports between Hispanics and Caucasians with serious health problems in a nationally representative sample determined that race, ethnicity, and socioeconomic factors all influence access to pain care. This data holds true for both cancer and non-cancer diagnoses. In fact, these disparities persist and may even be more pronounced as patients become seriously and terminally ill. In this interactive session, multidisciplinary participants will use data and immersive exercises to understand three common contributed barriers and three common clinician-contributed barriers to effective pain care for multicultural patients. Immersive exercises will be used to unmask implicit biases that are prevalent among clinicians. Strategies to overcome these barriers will be reviewed and we will identify two practical solutions to optimize pain care in clinical practice.
Paper Session A Double-Blind Placebo-Controlled Trial of Melatonin for Appetite in Patients with Cancer Cachexia (TH307-A) Egidio Del Fabbro, MD, Virginia Commonwealth University, Richmond, VA. (Del Fabbro has no relevant financial relationships to disclose.) Objectives 1. Increased awareness of the use and limitations of melatonin for symptom management. 2. Increased awareness of the limitations of past trials, including their design and outcome measurements. 3. Increased screening and identification of patients with cancer cachexia. Background. Patients with advanced cancer experience anorexia and weight loss which impairs their quality of life. Prior studies suggest melatonin, a frequently used integrative medicine may attenuate weight loss, anorexia, fatigue, and depression. These studies were limited by a lack of
Schedule With Abstracts
developed pediatric palliative medical homes that seek to meet the needs of children and their families by delivering palliative care in a primary care context, thus bridging the gap between inpatient palliative care programs and hospice services. Lessons learned and challenges experienced will be shared with the audience. Levels of service and types of patients served as well as selection criteria will be described. Presenters will share case scenarios to demonstrate trajectories of patients through care settings, from inpatient to clinic to home. Finally, through questions and comments from participants, caveats and innovative ideas will be elicited and explored.
Last Among Equals? Identifying and Managing Pain Disparities in Multicultural Populations (TH306) Vyjeyanthi Periyakoil, MD, Stanford University, Palo Alto, CA. (Periyakoil had no relevant financial relationships to disclose.) Objectives 1. Review current data related to disparities in pain care and identify three common reasons underlying pain care disparities. 2. Use immersive exercises and case studies to identify implicit biases and unconscious stereotypes and how these may influence the behavior of clinicians. 3. Identify simple strategies to improve pain care for your patients from multicultural backgrounds. The influence of race and ethnicity on access to health care is a major issue in the United States. Consistent with the Institute of Medicine’s report on healthcare disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (e.g., postoperative, emergency room) and across all types of pain (e.g., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/healthcare provider communication, attitudes), healthcare provider (e.g., decision making), and healthcare system (e.g., access to pain medication) factors. The way that pain is perceived and the way it is dealt with is largely influenced by the ethnocultural background of the individuals and families experiencing the pain. Significant racial- and ethnic-based differences in the pain care
335
experience have been described. A recent study showed that racial and ethnic minorities undergoing hip and knee arthroplasty appear to have worse patient-perceived outcomes (well-being, pain, and function) when compared to whites, with this discrepancy being most pronounced for African Americans. Another large study examining ethnic differences in pain reports between Hispanics and Caucasians with serious health problems in a nationally representative sample determined that race, ethnicity, and socioeconomic factors all influence access to pain care. This data holds true for both cancer and non-cancer diagnoses. In fact, these disparities persist and may even be more pronounced as patients become seriously and terminally ill. In this interactive session, multidisciplinary participants will use data and immersive exercises to understand three common contributed barriers and three common clinician-contributed barriers to effective pain care for multicultural patients. Immersive exercises will be used to unmask implicit biases that are prevalent among clinicians. Strategies to overcome these barriers will be reviewed and we will identify two practical solutions to optimize pain care in clinical practice.
Paper Session A Double-Blind Placebo-Controlled Trial of Melatonin for Appetite in Patients with Cancer Cachexia (TH307-A) Egidio Del Fabbro, MD, Virginia Commonwealth University, Richmond, VA. (Del Fabbro has no relevant financial relationships to disclose.) Objectives 1. Increased awareness of the use and limitations of melatonin for symptom management. 2. Increased awareness of the limitations of past trials, including their design and outcome measurements. 3. Increased screening and identification of patients with cancer cachexia. Background. Patients with advanced cancer experience anorexia and weight loss which impairs their quality of life. Prior studies suggest melatonin, a frequently used integrative medicine may attenuate weight loss, anorexia, fatigue, and depression. These studies were limited by a lack of