Reynolds Morrison1, Bill Jesdale1, Catherine Dube1, Sarah Forrester1, Anthony Nunes1, Carol Bova2, Kate L Lapane3. 1. Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA. 2. School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA. 3. Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA. Electronic address: Kate.lapane@umassmed.edu.
Abstract
CONTEXT: Nonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented. OBJECTIVES: We sought to examine racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain. METHODS: We used the U.S. national Minimum Data Set 3.0 and identified 994,510 newly admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010 and 2016. Adjusted prevalence ratios (aPRs) and 95% CIs estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups. RESULTS: Vocal complaints were most commonly recorded (18.3% non-Hispanic black residents, 19.3% of Hispanic residents, and 30.3% of non-Hispanic white residents). Documentation of pain behaviors was less frequent among non-Hispanic black and Hispanic residents than non-Hispanic white residents (e.g., vocal complaints: aPRBlack: 0.76; 95% CI: 0.73-0.78; with similar estimates for other pain behaviors). Non-Hispanic blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared with non-Hispanic white residents (59.3%) (aPRBlack: 0.87; 95% CI: 0.86-0.88; aPRHispanics: 0.87; 95% CI: 0.84-0.89). CONCLUSION: Among residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic blacks and Hispanics than in non-Hispanic white residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.
CONTEXT: Nonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented. OBJECTIVES: We sought to examine racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain. METHODS: We used the U.S. national Minimum Data Set 3.0 and identified 994,510 newly admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010 and 2016. Adjusted prevalence ratios (aPRs) and 95% CIs estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups. RESULTS: Vocal complaints were most commonly recorded (18.3% non-Hispanic black residents, 19.3% of Hispanic residents, and 30.3% of non-Hispanic white residents). Documentation of pain behaviors was less frequent among non-Hispanic black and Hispanic residents than non-Hispanic white residents (e.g., vocal complaints: aPRBlack: 0.76; 95% CI: 0.73-0.78; with similar estimates for other pain behaviors). Non-Hispanic blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared with non-Hispanic white residents (59.3%) (aPRBlack: 0.87; 95% CI: 0.86-0.88; aPRHispanics: 0.87; 95% CI: 0.84-0.89). CONCLUSION: Among residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic blacks and Hispanics than in non-Hispanic white residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.
Authors: Debra Saliba; Malia Jones; Joel Streim; Joseph Ouslander; Dan Berlowitz; Joan Buchanan Journal: J Am Med Dir Assoc Date: 2012-07-10 Impact factor: 4.669
Authors: Robert S Eisinger; Zachary A Sorrentino; Brandon Lucke-Wold; Sonya Zhou; Brooke Barlow; Brian Hoh; Carolina B Maciel; Katharina M Busl Journal: Brain Inj Date: 2022-03-30 Impact factor: 2.167
Authors: Katie Fitzgerald Jones; Esther Laury; Justin J Sanders; Lauren T Starr; William E Rosa; Staja Q Booker; Melissa Wachterman; Christopher A Jones; Susan Hickman; Jessica S Merlin; Salimah H Meghani Journal: J Palliat Med Date: 2021-11-16 Impact factor: 2.947
Authors: Barbara Resnick; Kimberly Van Haitsma; Ann Kolanowski; Elizabeth Galik; Marie Boltz; Jeanette Ellis; Liza Behrens; Karen Eshraghi Journal: J Nurs Care Qual Date: 2021-11-12 Impact factor: 1.728
Authors: Barbara Resnick; Kimberly Van Haitsma; Ann Kolanowski; Elizabeth Galik; Marie Boltz; Jeanette Ellis; Liza Behrens; Karen Eshraghi; Cynthia L Renn; Susan G Dorsey Journal: Front Pain Res (Lausanne) Date: 2021-12-02