Can Patient Coaching Reduce Racial/Ethnic Disparities in Cancer Pain Control? Secondary Analysis of a Randomized Controlled Trial

  1. Donna Kalauokalani MD, MPH1,2,*,
  2. Peter Franks MD2,3,
  3. Jennifer Wright Oliver MD2,
  4. Frederick J. Meyers MD2,4,
  5. Richard L. Kravitz MD, MSPH2,4

Article first published online: 23 JAN 2007

DOI: 10.1111/j.1526-4637.2007.00170.x

Issue

Pain Medicine

Pain Medicine

Volume 8, Issue 1, pages 17–24, January/February 2007

Additional Information

How to Cite

Kalauokalani, D., Franks, P., Oliver, J. W., Meyers, F. J. and Kravitz, R. L. (2007), Can Patient Coaching Reduce Racial/Ethnic Disparities in Cancer Pain Control? Secondary Analysis of a Randomized Controlled Trial. Pain Medicine, 8: 17–24. doi: 10.1111/j.1526-4637.2007.00170.x

Author Information

  1. 1

    Department of Anesthesiology and Pain Medicine, Division of Pain Medicine;

  2. 2

    Center for Health Services Research in Primary Care;

  3. 3

    Department of Family and Community Medicine;

  4. 4

    Department of Internal Medicine, University of California, Davis, California, USA

*Donna Kalauokalani, MD, MPH, UC Davis Division of Pain Medicine, 4860 Y St. Suite 3020, Sacramento, CA 95817, USA. Tel: 916-734-8019; Fax: 916-734-6827; E-mail: dkalauokalani@ucdavis.edu

Publication History

  1. Issue published online: 23 JAN 2007
  2. Article first published online: 23 JAN 2007

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Keywords:

  • Cancer Pain;
  • Racial Disparities;
  • Ethnic Minorities;
  • Communication;
  • Physician–Patient Relations;
  • Patient Activation

ABSTRACT

Purpose.  Minority patients with cancer experience worse control of their pain than do their white counterparts. This disparity may, in part, reflect more miscommunication between minority patients and their physicians. Therefore, we examined whether patient coaching could reduce disparities in pain control in a secondary analysis of a randomized controlled trial.

Methods.  Sixty-seven English-speaking adult cancer outpatients, including 15 minorities, with moderate pain over the prior 2 weeks were randomly assigned to the experimental (N = 34) or control group (N = 33). Experimental patients received a 20-minute individualized education and coaching session to increase knowledge of pain self-management, to redress personal misconceptions about pain treatment, and to rehearse an individually scripted patient–physician dialog about pain control. The control group received standardized information on controlling pain. Data on average pain (0–10 scale) were collected at enrollment and 2-week follow-up.

Results.  At enrollment, minority patients had significantly more pain than their white counterparts (6.0 vs 5.0, P = 0.05). At follow-up, minorities in the control group continued to have more pain (6.4 vs 4.7, P = 0.01), whereas in the experimental group, disparities were eliminated (4.0 vs 4.3, P = 0.71). The effect of the intervention on reducing disparities was significant (P = 0.04).

Conclusions.  Patient coaching offers promise as a means of reducing racial/ethnic disparities in pain control. Larger studies are needed to validate these findings and to explore possible mechanisms.

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