Systematic Review of Pain Research Among Limited English Proficiency Patient Populations in Health care

Trends in Outpatient Opioid Prescriptions for Cancer Pain Between 2016 and 2021

PURPOSE

Increasing opioid regulations have resulted in reduced opioid prescriptions, including for cancer pain, despite guideline exemptions. Data after 2017 following the Centers for Disease Control's 2016 pain management guidelines are limited on opioid prescribing practices of oncologists. The purpose of this study was to examine the trend in dose of opioids prescribed by oncologists to patients with cancer pain referred to outpatient palliative care between 2016 and 2021.

METHODS

A single-center, cross-sectional, retrospective study was conducted at a tertiary cancer center's outpatient palliative care clinic including 375 adult patients referred for initial consultation for cancer pain between 2016 and 2021. The main outcome was the trend in prescribed opioid doses, expressed as morphine-equivalent daily dose in mg/day. Additional analyses were conducted to identify predictors of opioid prescriptions.

RESULTS

The median age (range) was 61 (19-85), 50% were women, 67% were non-Hispanic White, 80% had advanced cancer, and 91% reported proficiency in English. Ninety-five percent had solid tumors, predominantly GI (22%), breast (15%), and genitourinary (14%). From 2016 to 2021, the median dose of opioids decreased from 37.5 to 7.5 (P < .001). The proportion of patients on long-acting opioid decreased from 26% to 12% (P = .019), whereas that of patients without opioids increased from 28% to 41% (P = .008). CAGE-AID score (reflecting potential for substance abuse; β Coefficient, 43.2 [95% CI, 23.3 to 63.2], P < .001) and pain on the Edmonton Symptom Assessment Scale (5.77 [95% CI, 2.6 to 8.9], P < .001) predicted higher opioid dose, whereas non-English language predicted lower dose (-26.9 [95% CI, -53.1 to -0.8], P = .043).

CONCLUSION

During the study period, we observed a five-fold decline in opioid dose prescribed by oncologists for cancer pain. This raises concerns for undertreatment of pain in patients with cancer.

Pain Management Among Older Farsi and Azeri Speaking Immigrant Adults With Limited English Proficiency (LEP): Interpretive Approach

OBJECTIVES

Pain is a major public health issue in the United States. The ability to communicate the severity of pain with healthcare providers is crucial to receiving appropriate pain management. Many factors can limit this ability, including limited proficiency in the language spoken by providers. This body of research suggests gaps in the multidimensional approach to pain management for older adults with limited English proficiency (LEP). In this study, we describe the lived experiences of pain management of older adults with LEP living with chronic pain in the United States.

METHODS

We used a qualitative interpretive approach with semi-structured interviews from nineteen Farsi and Azeri-speaking older adults with LEP and chronic pain to describe the lived experiences of older adults with LEP.

RESULTS

Participants relied on alternative medicine to manage their pain and reported fears of becoming dependent on prescription pain medications. Some reported poor physician-patient rapport and felt unseen by healthcare providers, and all reported language barriers even with the use of translators.

CONCLUSIONS

Farsi and Azeri-speaking older adults with LEP and chronic pain felt the US healthcare system ignored their social, cultural, and linguistic needs. Pain management training for healthcare providers should address language barriers and include cultural competency.

Improving pain communication between limited English-speaking Hmong patients, medical interpreters, and health care providers in primary care: A pilot study

This pilot study assessed the feasibility of implementing a pain assessment information visualization (InfoViz) tool to address cultural and language barriers among limited English proficiency (LEP) Hmong patients in primary care. We used a static group comparison design to collect data from 20 patient, interpreter, and provider triads under usual care (i.e., interpreter using verbal pain descriptions), followed by another 20 triads under the intervention (i.e., interpreter using verbal pain descriptions and the InfoViz tool). Feasibility outcomes included recruitment and retention rates, InfoViz tool completion, acceptability, and fidelity. We also assessed mutual understanding (MU) and pain electronic health record (EHR) documentation. Descriptive data were calculated and thematic analysis was conducted. Thirty-six LEP Hmong patients (n = 29 female, mean age = 59.03), 27 providers (n = 15 female), and four interpreters participated in this study. The patient recruitment rate was 18% while the retention rate was 81%. Interpreter recruitment rate was 80%, and 75% for retention rate. The intervention fidelity mean score was 83%. In the intervention condition, patient-provider MU of pain severity improved by 30%, coupled with a 28% increase in pain severity EHR documentation compared to usual care. While communication of pain quality did not improve, there was a higher mean number of pain descriptors (3.31 in the intervention vs. 1.79 in usual care) in EHR documentation. All participants had a positive experience with the tool, reporting it as valuable with 100% completeness of all tools. Findings revealed the tool was acceptable and feasible to use among LEP patients-interpreters-providers, providing support for an efficacy study.