The Color of Cancer:
U-M Comprehensive Cancer Center works to eliminate racial, ethnic health disparities, con't
SPEAKING UP ABOUT PAIN
For minorities, women and older adults,
cancer pain is less likely to be assessed,
according to Carmen R. Green, M.D., a
professor at the U-M Medical School and
a pain medicine physician at the U-M
Cancer Center. And even if it is, minorities
and women are more likely to receive
suboptimal treatment.
Bonita Cowan-Tucker, of Bethel A.M.E. Church of Ann Arbor. The U-M Body
& Soul program has helped to promote health education among the 600-member congregation.
Green says the reasons for this are unclear: Are minorities, women and older
adults less likely to complain about pain to providers? Do myths about pain prevent
them from seeking treatment? Do they have less access to care? Are providers dismissing
their complaints? One study has suggested that pharmacies in minority neighborhoods
may be less likely to carry prescription pain medications, but more research is necessary
to understand the full nature of the problem.
In the meantime, Green is seeking to educate people about the importance of pain
management. Pain robs patients of their health and well-being, but many treatment
options are available, from physical therapy to nerve blocks. Green encourages patients
to talk to their providers about pain.
"We also need to be engaged in public policy at a national level," Green said. "Our
country only spends a small percentage of research dollars on pain, and with more
people surviving cancer, we're likely to see a pain epidemic. As a society, we need to
hear firsthand from patients why this is an important issue."
IMPROVING COMMUNICATION
As Green's research indicates, communication breakdowns may be occurring
between minority patients and their healthcare teams. Sarah Hawley, Ph.D., M.P.H.,
an associate professor of internal medicine at the U-M Comprehensive Cancer
Center, has surveyed breast cancer patients to determine how much they understand
about concepts related to their diagnosis.
Her study found that all patients had gaps in understanding, but it was worse among
African-Americans and Latinas. In addition, a separate study of
Hawley's has shown that Latina women -- many of whom primarily spoke Spanish -- who were less integrated into American
society were more likely to be dissatisfied
or regret treatment decisions.
"To make an informed decision about surgery or other treatment options, you
have to be able to understand the risks and benefits," Hawley said. "We know
that people of different cultures receive
information differently. We know there are
opportunities to improve the way healthcare providers communicate, even among
the general population."
Hawley's group is piloting a Web-based intervention that will help patients at the
U-M Cancer Center and the Karmanos Cancer Institute in Detroit consider the
risks and benefits of treatment options. She is also working on another study to record doctor-patient conversations to
analyze differences in communication styles among white, African-American and Latina
patients.
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