Can patient coaching reduce racial/ethnic disparities in cancer pain control? Secondary analysis of a randomized controlled trial.
OBJECTIVE
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.
Kalauokalani
Donna
D
Department of Anesthesiology and Pain Medicine, Division of Pain Medicine, University of California, Davis, California, USA. dkalauokalani@ucdavis.edu
Franks
Peter
P
Oliver
Jennifer Wright
JW
Meyers
Frederick J
FJ
Kravitz
Richard L
RL
D003142:Communication; D003144:Communication Barriers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000453:epidemiology* / Q000209:etiology; D059408:Pain Management; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic