Barriers to Pain Management: Incongruence in Black Cancer Caregiving Dyads

• Type of Material: Article
• Authors: Kalisha Johnson, Emory University; Jinbing Bai, Emory University; Drenna Waldrop, Emory University; Sudeshna Paul, Emory University; Haerim Lee, Emory University; Karen S Lyons, Boston College; Katherine Yeager, Emory University
• Language: English
• Date: 2022-04-12
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpainsymman.2021.12.033
• Title of Journal or Parent Work: JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
• Volume: 63
• Issue: 5
• Start Page: 711
• End Page: 720
• Keywords: PERCEPTIONS; adherence; Neurosciences & Neurology; Cancer pain; Life Sciences & Biomedicine; HEALTH; LUNG-CANCER; opioids; African American; black American; INTERFERENCE; Clinical Neurology; TAIWANESE PATIENTS; OUTPATIENTS; CARE; FAMILY CAREGIVERS; black race; Medicine, General & Internal; Health Care Sciences & Services; General & Internal Medicine; caregivers; INVENTORY; Science & Technology; PATIENT

Abstract

Context: To effectively manage cancer pain, there is a need to understand how caregiving dyads appraise symptoms. Dyadic appraisal of symptoms influences whether the dyad perceives the patient's pain is managed well and whether they are on the same page with their appraisal. Beliefs can act as barriers to the dyadic appraisal. Objectives: This secondary data analysis examined incongruence within Black cancer caregiving dyads regarding beliefs about pain management and potential medication side effects using the Barriers Questionnaire-13. Associated factors were also examined. Methods: Guided by the Theory of Dyadic Illness Management, dyadic multilevel modeling was conducted with data from 60 Black cancer caregiving dyads to determine the dyadic appraisal of beliefs about pain management and potential medication side effects, which includes the average perception of barriers within the dyad (i.e., dyadic average) and the dyadic incongruence (i.e., gap between patient and caregiver). Results: On average, Black cancer caregiving dyads reported moderate barriers regarding pain management (2.262 (SE=0.102, P<0.001) and medication side effects (2.223 (SE=0.144, P<0.001). There was significant variability across dyads regarding barriers to pain management and medication side effects. Lower patient education and higher patient-reported pain interference were significantly associated with more perceived barriers to pain management and potential medication side effects. Incongruence within dyads regarding barriers to pain management and medication side effects were significantly associated with the caregiver's report of patient's pain interference. Conclusion: Findings suggest the importance of appraisal that includes both members of Black cancer caregiving dyads regarding pain management.