Minorities undertreated for pain, illness

Medical schools urged to improve training for end-of-life care

May 26, 2002|By Maia Davis | Maia Davis,KNIGHT RIDDER/TRIBUNE

HACKENSACK, N.J. - America's poor and minorities live harder lives, judging by income levels. They also die more painful deaths.

African-Americans make up only 8 percent of participants in hospice care, which is aimed at providing comfort to dying patients and their families, while 83 percent are white. Minorities are also less likely in general to receive pain medication, regardless of their incomes or insurance status.

One reason is that minorities fear doctors may attempt to make their deaths easier instead of aggressively trying to keep them alive, experts said at a recent conference titled "Palliative Care for the Medically Underserved."

"Why should we ever buy into a program that makes us more comfortable with dying when there are major questions about fairness in treatment of the living?" said Dr. Richard Payne, an African-American physician who is chief of pain and palliative care at Memorial Sloan-Kettering Cancer Center in New York.

Racial disparities in end-of-life care mirror the unequal treatment of minorities in other areas of health care, Payne said to the audience of about 50 health care providers and community advocates at the University of Medicine and Dentistry of New Jersey-University Hospital in Newark.

Disparities

Blacks have a 33 percent higher death rate from cancer than whites, he said, adding that recent research on the human genome found no significant distinction between the races to account for such a difference in mortality.

Blacks are also less likely than whites to receive surgery for early-stage lung cancer, which is the only way to survive the disease, Payne said. And, blacks are admitted to intensive-care units less often than whites, he said.

Such differences in treatment fuel minorities' suspicion of the health care system, he said. Blacks are also aware of the history of medical exploitation of them. Most infamous is the Tuskegee experiment, in which the U.S. Public Health Service promised to treat hundreds of African-American men who had syphilis, but instead monitored their cases for 40 years with no effort at curing them.

"The system has behaved in ways that makes the system less than trustworthy," Payne said.

Minorities' distrust of the medical establishment reaches a peak with serious or terminal illnesses, "where people are their most vulnerable and where the stakes are the highest," he said.

Although Americans in general get too little pain relief when injured or ill, minorities suffer the most, said Dr. Stacie Pinderhughes, an assistant professor at Mount Sinai School of Medicine in New York City.

A study of patients with serious bone fractures showed that Hispanics were twice as likely as whites to receive no pain medication. Blacks were 66 percent more likely than whites to get none, Pinderhughes said.

Ethnicity issue

She said studies have concluded that doctors' decisions on giving pain relief were greatly influenced by the patients' ethnicity.

Even when doctors prescribe painkillers, minority patients may have trouble getting them. One study in New York City found that only 25 percent of pharmacies in predominantly non-white neighborhoods carried opioids such as morphine, used for relieving the pain of advanced cancer, compared with 70 percent in mostly white areas.

Among reasons for this, pharmacists in high-crime neighborhoods may fear theft of these drugs, Payne said. They may also be less likely to stock painkillers for which there is little demand.

Pinderhughes and Payne called for medical schools to improve their training in end-of-life care, and for doctors to consider how their unconscious racial stereotypes of patients may influence treatment decisions.

"We all need to be honest with ourselves," Pinderhughes said.

The medical establishment must also begin working with minority community leaders to raise awareness of the benefits of planning for a comfortable death, she said. In doing so, they must be sensitive to the spiritual beliefs and cultural traditions of different minorities.

Doctors could, for example, present hospice care to African-Americans as "compatible with caring for one's own death, as homecoming, as God's will," Pinderhughes said.

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