Grant R01CA149432

Improving Functional Status in African Americans with Cancer Pain

DESCRIPTION (provided by applicant): Pain is the most common and distressing symptom experienced by cancer patients and often lowers functional status. Our prior research showed that these disparities arise in part from a lower perception of control over pain. A great deal of clinical experience and research has shown that interventions need to be highly individualized and responsive to the rapidly-changing needs of patients with pain. Because of this, and with shorter hospital stays, patients and their caregivers are more than ever responsible for daily pain and symptom management. Unfortunately, they are not typically prepared for this responsibility. Including both patients and caregivers in interventions is essential since caregivers'beliefs directly affect pain management success. Our ultimate goal is to improve the function of diverse patients with chronic pain. To help cancer patients and caregivers effectively manage pain, we developed and tested a 1-session intervention that included medication management and pain advocacy content. That study showed the central role of perception of control over pain in self management. We are now expanding the intervention to include a third component called Living with Pain. The Living with Pain component is new in the cancer pain population where it can be helpful in maximizing function in spite of pain. We are also increasing the number and type of visits (dose) and providing continuous access for problem solving. Among cancer patients, African Americans report the highest levels of pain and symptom distress, and lower levels of function. Our prior research showed that these disparities arise in part from lower perceptions of control over pain. The new intervention, Power Over Pain - Coaching (POP-C), is tailored to the culture of African American cancer patients and their caregivers and individualized to the unique needs of each patient and caregiver. The purpose of the study is to determine the efficacy of the POP-C intervention to improve function among African American outpatients with cancer pain. This study will contribute significantly to the advancement of pain research by addressing a challenge of treatment that has remained unsolved for a traditionally under-represented minority. When shown to be effective, this intervention can then be adapted for other diverse populations with cancer-related pain or chronic non-cancer pain. PUBLIC HEALTH RELEVANCE: Social justice is the core value of the American public health system. African American cancer patients bear a disproportionate burden from pain and the resultant limitations in function. Excess morbidity from inadequately managed cancer pain in the African American community results in high levels of human suffering, increased family caregiver burdens, and both hidden and explicit economic costs. Effective nursing interventions such as the Power over Pain - Coaching program being tested in this study hold great promise for pain relief among individual cancer patients and their families while we work towards an end to the current systemic disparities in access, treatment, and outcomes.