Evidence map›Paper›PMID 30632104›Full record

Trial reportJournal of general internal medicine2019

The Influence of Patient Race and Activation on Pain Management in Advanced Lung Cancer: a Randomized Field Experiment.

Cleveland G Shields, Jennifer J Griggs, Kevin Fiscella, Cezanne M Elias, Sharon L Christ, Joseph Colbert, Stephen G Henry, Beth G Hoh, Haslyn E R Hunte, Mary Marshall and 5 more

Registry-linked trialOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01501006 (Social and Behavioral Influences on Clinical Care), which is not on this map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
2.7field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01501006 completednot on this map

Social and Behavioral Influences on Clinical Care

TypeobservationalSponsorUniversity of RochesterRan2010 to 2017Enrolled96ConditionsCommunication
3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 15 citations in OpenAlex.

  1. Trial
  2. Article
  3. Article
  4. Review
  5. Examining the effects of physician burnout on pain management for patients with advanced lung cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2023
    Article
  6. Patient activation reduces effects of implicit bias on doctor-patient interactions.Proceedings of the National Academy of Sciences of the United States of America · 2022
    Article
  7. Article
  8. Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 5 institutions in 1 country.

Cleveland G ShieldsCenter for Cancer Research, Purdue University, West Lafayette, IN, USA.
Jennifer J GriggsDepartment of Internal Medicine, Hematology/ Oncology Division, and Health Management and Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA.
Kevin FiscellaCenter for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.
Cezanne M EliasHuman Development & Family Studies, Purdue University, West Lafayette, IN, USA.
Sharon L ChristHuman Development & Family Studies, Purdue University, West Lafayette, IN, USA.
Joseph ColbertDepartment of Biostatistics, University of Michigan School of Medicine, Ann Arbor, MI, USA.
Stephen G HenryDepartment of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
Beth G HohDepartment of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.
Haslyn E R HunteSchool of Public Health, Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA.
Mary MarshallHuman Development & Family Studies, Purdue University, West Lafayette, IN, USA.
Supriya Gupta MohileJames P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.
Sandy PlumbCenter for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.
Mohamedtaki A TejaniJames P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.
Alison VenutiCenter for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.
Ronald M EpsteinCenter for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA. ronald_epstein@urmc.rochester.edu.
University of Rochester · USPurdue University West Lafayette · USUniversity of Michigan–Ann Arbor · USUniversity of California, Davis · USWest Virginia University · US

Funding

Social and behavioral influences on clinical communication and pain managementR01CA155376 · NCI · PURDUE UNIVERSITY · PI EPSTEIN, RONALD M., SHIELDS, CLEVELAND GEORGE · 2011 to 2015
$2.6M
A Patient-Oriented Research Program in Geriatric OncologyK24AG056589 · NIA · UNIVERSITY OF ROCHESTER · PI Supriya G. Mohile · 2018 to 2026
$1.5M
A clinician training intervention to improve pain-related communication, pain management and opioid prescribing in primary careK23DA043052 · NIDA · UNIVERSITY OF CALIFORNIA AT DAVIS · PI HENRY, STEPHEN G · 2017 to 2019
$591k
NCI NIH HHS R01 CA155376NIA NIH HHS K24 AG056589NIDA NIH HHS K23 DA043052
6 · The paper itself

Abstract

backgroundPain management racial disparities exist, yet it is unclear whether disparities exist in pain management in advanced cancer.

objectiveTo examine the effect of race on physicians' pain assessment and treatment in advanced lung cancer and the moderating effect of patient activation.

designRandomized field experiment. Physicians consented to see two unannounced standardized patients (SPs) over 18 months. SPs portrayed 4 identical roles-a 62-year-old man with advanced lung cancer and uncontrolled pain-differing by race (black or white) and role (activated or typical). Activated SPs asked questions, interrupted when necessary, made requests, and expressed opinions.

participantsNinety-six primary care physicians (PCPs) and oncologists from small cities, and suburban and rural areas of New York, Indiana, and Michigan. Physicians' mean age was 52 years (SD = 27.17), 59% male, and 64% white. MAIN MEASURES: Opioids prescribed (or not), total daily opioid doses (in oral morphine equivalents), guideline-concordant pain management, and pain assessment. KEY

resultsSPs completed 181 covertly audio-recorded visits that had complete data for the model covariates. Physicians detected SPs in 15% of visits. Physicians prescribed opioids in 71% of visits; 38% received guideline-concordant doses. Neither race nor activation was associated with total opioid dose or guideline-concordant pain management, and there were no interaction effects (p > 0.05). Activation, but not race, was associated with improved pain assessment (ẞ, 0.46, 95% CI 0.18, 0.74). In post hoc analyses, oncologists (but not PCPs) were less likely to prescribe opioids to black SPs (OR 0.24, 95% CI 0.07, 0.81).

conclusionsNeither race nor activation was associated with opioid prescribing; activation was associated with better pain assessment. In post hoc analyses, oncologists were less likely to prescribe opioids to black male SPs than white male SPs; PCPs had no racial disparities. In general, physicians may be under-prescribing opioids for cancer pain.

trial registrationNCT01501006.

Indexed as

AdultAgedAnalgesics, OpioidCancer PainDrug PrescriptionsFemaleHumansLung NeoplasmsMaleMiddle AgedPain ManagementPatient ParticipationPhysiciansRacial GroupsAnalgesics, Opioidcommunicationdoctor-patient relationslung cancerpain managementracial disparities

Identifiers

PMID30632104
PMCPMC6420510
OpenAlexW2911099714

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.