Factors Related to Adherence to Opioids in Black Patients With Cancer Pain

• Type of Material: Article
• Authors: Bryan Williams, Emory University; Katherine Yeager, Emory University; Jinbing Bai, Emory University; Hannah Cooper, Emory University; Tammie Quest, Emory University; Salimah H. Meghani, University of Pennsylvania; Deborah Bruner, Emory University
• Language: English
• Date: 2019-01-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 American Academy of Hospice and Palliative Medicine
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpainsymman.2018.10.491
• Title of Journal or Parent Work: Journal of Pain and Symptom Management
• Volume: 57
• Issue: 1
• Start Page: 28
• End Page: 36
• Grant/Funding Information: This study was supported by the National Institutes of Health, National Institute of Nursing Research, 1K01NR014673. REDCap is supported in part by the National Institutes of Health (NIH/NCATS UL1 TR000445)
• Keywords: Neurosciences & Neurology; PERCEIVED SOCIAL SUPPORT; Health Care Sciences & Services; Life Sciences & Biomedicine; PREDICTORS; Medicine, General & Internal; Clinical Neurology; MEDICATION ADHERENCE; MULTIDIMENSIONAL SCALE; ONCOLOGY OUTPATIENTS; General & Internal Medicine; AFRICAN-AMERICANS; ANALGESIC ADHERENCE; adherence; Black race; MANAGEMENT; electronic monitoring; Cancer pain; opioids; SYMPTOMS; VALIDATION; Science & Technology

Abstract

Context: Cancer pain relief is often inadequate because of poor adherence to pain medication, especially for black patients. Objectives: The purpose of this study is to describe factors related to adherence to around-the-clock opioids among 110 black patients being treated for cancer pain. Methods: Sociodemographic, clinical, symptoms, and social support data were collected at baseline; pain and adherence data were collected at 30 days. Associations between these variables and opioid adherence measured by Medication Event Monitoring System were estimated using multiple regression. Results: Mean age was 56 (±10.1), the majority were women (63%) and college educated (56%). Mean pain severity at baseline equaled 4.6 (±2.3). Mean dose adherence was 60% (±28.5), while mean schedule adherence was 33.0% (±31.0). In adjusted analysis, 26% of the variance in dose adherence was explained by recent chemotherapy, changes in pain, concerns about nausea, and doctors’ focus on cure versus pain control (P<0.001); 27% of the variance in schedule adherence was explained by recent chemotherapy, changes in pain, symptom burden, and concerns about doctors focus on cure versus pain control (P<0.001). Conclusion: Findings confirm pain medication adherence is poor and pain was not well relieved. Multiple factors influence adherence to around-the-clock opioids. Clinicians need to partner with patients by providing a personalized pain treatment plan including an in-depth assessment of treatment choices and adherence.