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Palliative care in the inner city†

Patient Religious Affiliation, Underinsurance, and Symptom Attitude

  1. Richard B. Francoeur PhD1,‡,*,
  2. Richard Payne MD2,
  3. Victoria H. Raveis PhD3,
  4. Hyunjung Shim MSW4

Article first published online: 5 DEC 2006

DOI: 10.1002/cncr.22363

Issue

Cancer

Cancer

Supplement: Exploring Models to Eliminate Cancer Disparities Among African American and Latino Populations: Research and Community Solutions

Volume 109, Issue Supplement 2, pages 425–434, 15 January 2007

Additional Information

How to Cite

Francoeur, R. B., Payne, R., Raveis, V. H. and Shim, H. (2007), Palliative care in the inner city. Cancer, 109: 425–434. doi: 10.1002/cncr.22363

Author Information

  1. 1

    School of Social Work, Adelphi University, Garden City, New York

  2. 2

    Institute on Care at the End of Life, Divinity School, Duke University, Durham, North Carolina

  3. 3

    Center for the Psychosocial Study of Health and Illness, Mailman School of Public Health, Columbia University, New York, New York

  4. 4

    School of Social Work, Columbia University, New York, New York

  1. ‡

    Fax: 212-851-2206

*School of Social Work, 1 South Avenue, Box 701, Garden City, NY 11530

  1. †

    Presented at Exploring Models to Eliminate Cancer Disparities Among African American and Latino Populations: Research and Community Solutions, Atlanta, Georgia, April 21–22, 2005.

Publication History

  1. Issue published online: 8 JAN 2007
  2. Article first published online: 5 DEC 2006
  3. Manuscript Accepted: 6 SEP 2006
  4. Manuscript Received: 6 JUL 2006

Funded by

  • Grant funding from a Social Work Leadership Development Award (Project on Death in America (Open Society Institute))
  • The National Institute of Mental Health and The Hartford Geriatric Social Work Faculty Scholars Program

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Keywords:

  • religious affiliation;
  • uninsured;
  • Medicaid;
  • pain and symptom attitudes;
  • palliative care

Abstract

Many barriers, including being uninsured or having less than comprehensive health insurance coverage, reduce access to palliative and end–of-life care by inner city minorities. Medicaid or Medicare coverage alone can limit options for pain and symptom management, especially when late referrals make it more difficult to achieve symptom control. Patient affiliation with a religion could offset perceived difficulties with pain medication as well as negative pain and symptom attitudes. Data were analyzed from the most recent assessments of 146 African Americans and Latinos enrolled in an outpatient palliative care unit of an inner city hospital. Fifty-seven percent were receiving palliative care for cancer. Compared with other patients, patients with a religious affiliation did not differ regarding pain medication stress. Uninsured patients with a religious affiliation reported more hopeful pain and symptom attitudes, while patients with a religious affiliation covered only by Medicaid reported less hopeful pain and symptom attitudes. More hopeful pain and symptom attitudes by religious-affiliated, uninsured patients may reveal adequate coping, yet also conceal problem domains. Conversely, less hopeful attitudes by religious-affiliated patients covered only by Medicaid serve as clues to coping difficulties and problem domains. Palliative care programs should carefully consider how to integrate religious support networks as pipelines for program referrals and potential partners for care. Cancer 2007. © 2006 American Cancer Society.

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