Clarke Gemma, Chapman Emma, Crooks Jodie, Koffman Jonathan, Ahmed Shenaz, Bennett Michael I
Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK.
BMC Palliat Care. 2022 Apr 6;21(1):46. doi: 10.1186/s12904-022-00923-6.
Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups.
Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed.
Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping.
There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns.
PROSPERO- CRD42020167890 .
自20世纪90年代以来，在美国的急诊科和肿瘤科等环境中，人们观察到疼痛管理方面存在种族差异。然而，姑息治疗方面的情况描述得并不充分，而且很少有研究关注美国以外地区或晚期疾病。本综述采用跨国方法，探讨不同种族和族裔群体晚期疾病患者的疼痛管理。
混合方法系统综述。主要结局指标是不同种族和族裔群体患者在接受止痛药物方面的差异。检索了五个电子数据库。两名研究人员使用JBI清单独立评估质量、权衡证据并提取数据。对主要结局指标的定量研究结果进行交叉列表分析，并对混合方法研究进行主题分析。将主题整理成概念/主题矩阵。咨询了来自英国不同种族群体的患者代表。遵循PRISMA 2020指南。
18篇论文纳入主要结局分析。3篇论文证据权重被评为“高”，18篇中有17篇（94%）来自美国。18篇中有10篇（56%）发现不同种族群体患者在接受止痛药物方面无显著差异。46篇论文纳入混合方法综合分析；46篇中有41篇（89%）来自美国。关键主题：来自不同种族群体的患者担心耐受性、成瘾性和副作用。证据还表明：文化和社会层面的医患沟通问题；许多患者的疼痛管理需求未得到满足；不同种族群体在疼痛评估上存在差异，两项研究发现了种族和族裔刻板印象。
没有足够的高质量证据得出关于不同种族和族裔晚期疾病患者在接受止痛药物方面差异的结论。混合方法研究结果表明，不同种族群体对止痛药物副作用、耐受性和成瘾性的担忧存在共性。然而，这些担忧可能有不同的根源，并且根据文化、信仰、教育和社会因素有不同的优先级。需要制定具有文化胜任力的疼痛管理措施，以解决医患沟通问题和患者对疼痛管理的担忧。
PROSPERO - CRD42020167890
