title: Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study.
abstract: OBJECTIVE
  To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.
  
  
  METHODS
  This was a 3-mo prospective observational study (n= 207). Patients were included if they were adults (≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around-the-clock pain medication for cancer or cancer-treatment-related pain. Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia. A choice-based conjoint (CBC) analysis experiment was used to elicit analgesic treatment preferences (utilities). Patients employed trade-offs based on five analgesic attributes (percent relief from analgesics, type of analgesic, type of side-effects, severity of side-effects, out of pocket cost). Patients were clustered based on CBC utilities using novel adaptive statistical methods. Multiple logistic regression was used to identify predictors of cluster membership.
  
  
  RESULTS
  The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief (cluster 1, 41%). For a subset, the main underlying concern was type of analgesic prescribed,i.e., opioidvsnon-opioid (cluster 2, 11%) and type of analgesic side effects (cluster 4, 21%), respectively. About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects (cluster 3, 28%). In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors (education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief,i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1 (-); cluster 4 (+)].
  
  
  CONCLUSIONS
  Most patients appear to be driven by a single salient concern in using analgesia for cancer pain. Addressing these concerns, perhaps through real time clinical assessments, may improve patients' analgesic adherence patterns and cancer pain outcomes.
authors.affiliation: Salimah H Meghani, Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104-4217, United States.
authors.forename: Salimah H
authors.initials: SH
authors.lastname: Meghani
authors.affiliation: Salimah H Meghani, Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104-4217, United States.
authors.forename: George J
authors.initials: GJ
authors.lastname: Knafl
keywords: Analgesia; Cancer pain; Conjoint analysis; Opioids; Preferences; Side-effects