Improved Palliative Care for African Americans Sought

Memorial Sloan-Kettering Cancer Center
Wednesday, 2 January 2002

Representatives of approximately 100 national organizations will gather in Harlem January 3rd and 4th to discuss the medical, social, and spiritual supports needed to care for seriously ill and dying patients. The forum, called "Heritage, Health, and Hope," will provide opportunities among experts in medicine, healthcare policy, bioethics, and human services to shape new programs to improve palliative and end of life care for African Americans. Funded by a grant from the Project on Death in America, the Initiative is being propelled by the need to overcome the cultural, environmental, and economic barriers that exist among African Americans and other racial minorities to access timely, high-quality medical services and intervention throughout the continuum of disease, but especially pain control at the end oflife.

"Although more than 88 percent of patients can be treated successfully, there are studies that indicate pain is not optimally treated in almost half of the patients who report it," said Richard Payne, MD, Chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center and originator of the Initiative. "In fact minority individuals, particularly African Americans and Hispanics, are reported to be at about a threefold risk of under-treatment in some of these studies."

One study published in the April 6, 2000 issue of the New England Journal of Medicine found that pharmacies in minority neighborhoods do not stock enough painkillers. Only one in four drugstores in New York City's predominantly black and Hispanic neighborhoods could immediately fill a prescription if someone needed a strong painkiller such as morphine, whereas nearly three out of four pharmacies in largely white areas could fill the order. An accompanying editorial noted that this was just one of several studies documenting a disparity in treatment in which racial or ethnic issues seem to be the predominant factor.

Misconceptions about the likelihood of drug addiction and abuse among patients have resulted in avoidance of appropriate pain control by some patients and their doctors, according to Dr. Payne. But experts say the risk of addiction is very small, and therapies can be tailored to meet the individual needs of the patient.

The cost of effective pain management may be an even bigger barrier since some insurance companies will not cover some pain medications, and Medicare does not pay for oral drugs delivered outside the hospital setting.

Chronic pain can affect a person's physical, psychological, and emotional well being, and it can destroy quality of life. Palliative care is an increasingly common approach to care at the end of life in which both doctor and patient recognize that the disease cannot be cured but some quality of life can remain. This form of care focuses less on life-saving measures and more on relief of pain and other physical symptoms, while it addresses the patient's emotional, social, and spiritual needs.

According to Dr. Payne, many African Americans fear their cultural and personal values will not be respected when they are dying. They sometimes worry that their race and socioeconomic status make them more "disposable" and that treatment decisions will reflect that attitude. They also do not see palliative and hospice care as offering better care at the end of life.

"There needs to be better education among health care professionals in pain management and palliative care that should include better understanding of differences in the way blacks and whites perceive end of life care," said Dr. Payne, who will be one of the presenters at the conference. "Minority communities need better access to quality health care in general, and to physicians who are sensitive to minority attitudes toward end of life care."

The Initiative to Improve Palliative Care for African Americans will discuss ways of addressing many of these issues and come away with viable solutions that can be implemented on a local and national basis via the various groups in attendance. The forum will be moderated by Washington Post political writer and columnist Juan Williams, author of Eyes on the Prize, America's Civil Rights Years 1954-1965, and host of National Public Radio's daily news and talk show, "Talk of the Nation."

A panel of 11 presenters will lead the discussions, including LaVera Crawley, MD, executive director of the Initiative, and project director of a study on race, ethnicity, and trust in the doctor-patient relationship at the Stanford Center for Biomedical Ethics, and Harold Freeman, MD, medical director of the Ralph Lauren Center for Cancer Prevention and Care, director of surgery at North General Hospital, and Professor of Clinical Surgery at Columbia University College of Physicians andSurgeons.

Invited participants to the forum will include leaders from the NAACP, National Urban League, US Department of Health and Human Services, American Cancer Society, Association of American Medical Colleges, Harvard Medical School, Montifiore Medical Center, Albert Einstein College of Medicine, Tuskegee Bioethics Center, Robert Wood Johnson Foundation, Dana Farber Cancer Institute, National Black Nurses Association, Healthcare Finance Agency, National Hospice and Palliative Care Organization, and First Presbyterian Church in Brooklyn.

For more information, or to contact Memorial Sloan-Kettering Cancer Center, see their website at: www.mskcc.org