Tamara A. Baker

Beyond Race and Gender: Measuring Behavioral and Social Indicators of Pain Treatment Satisfaction in Older Black and White Cancer Patients

There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults.

Predictors of perceived vulnerability to cancer diagnoses among adult Black males

As much as the significance of age, education, masculinity, illness attitude, and self-esteem to preventive health have been reported, much less is known on how these factors predict perceived vulnerability to cancer diagnosis. This study aimed to determine the association between identified demographic, health, and social factors and perceived vulnerability to cancer diagnosis among adult Black males. Data reveal that incidences of cancer among Black men are contingent upon a myriad of psychological, social, and behavioral factors that are not exclusive but rather coexisting determinants of health.

The Relationship between Pain, Disability, and Sex in African Americans

Older African Americans consistently report diminished capacities to perform activities of daily living (ADL) compared with other racial groups. The extent to which bodily pain is related to declining abilities to perform ADL/ADL disability in African Americans remains unclear, as does whether this relationship exists to the same degree in African American men and women. For nurses to provide optimal care for older African Americans, a better understanding of the relationship between bodily pain and ADL disability and how it may differ by sex is needed. The aim of this study was to examine whether pain, age, education, income, marital status and/or comorbid conditions were associated with ADL disabilities in older African American women and men. This was a cross-sectional descriptive study. The sample included 598 participants (446 women, 152 men) from the first wave of the Baltimore Study on Black Aging. African American women (odds ratio [OR]xa0=xa04.06; 95% confidence interval [CI] 2.63-6.26) and African American men (ORxa0=xa06.44; 95% CIxa0=xa02.84-14.57) who reported bodily pain had greater ADL disability than those who did not report bodily pain. Having two or more comorbid conditions also was significantly associated with ADL disability in African American women (ORxa0=xa03.95; 95% CI: 2.09-7.47). Further work is needed to understand pain differences between older African American women and men to develop interventions that can be tailored to meet the individual pain needs of both groups.

Identifying factors of psychological distress on the experience of pain and symptom management among cancer patients

BackgroundEpidemiological evidence suggests the impact psychological distress has on symptomatic outcomes (pain) among cancer patients. While studies have examined distress across various medical illnesses, few have examined the relationship of psychological distress and pain among patients diagnosed with cancer. This study aimed to examine the impact psychological distress-related symptoms has on pain frequency, presence of pain, and pain-related distress among oncology patients.MethodsData were collected from a sample of White and Black adults (N = 232) receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing psychological distress (i.e., worry, feeling sad, difficulty sleeping), and health (pain presence, pain frequency, comorbidities, physical functioning), behavioral (pain-related distress), and demographic characteristics.ResultsPatients reporting functional limitations were more likely to report pain. Specifically, those reporting difficulty sleeping and feeling irritable were similarly likely to report pain. Data further showed age and feeling irritable as significant indicators of pain-related distress, with younger adults reporting more distress.ConclusionsIt must be recognized that psychological distress and experiences of pain frequency are contingent upon a myriad of factors that are not exclusive, but rather coexisting determinants of health. Further assessment of identified predictors such as age, race, socioeconomic status, and other physical and behavioral indicators are necessary, thus allowing for an expansive understanding of the daily challenges and concerns of individuals diagnosed with cancer, while providing the resources for clinicians, researchers, and policy makers to better meet the needs of this patient population.

Early Cancer Detection Behaviors among Black Males

Background and Objective: It is believed that the differentials in the chances of surviving cancer diagnoses may be due to barriers that limit access to timely, appropriate, and high-quality medical care. Understanding the motivation for early cancer detection behavior among Black males may begin to diminish the prevalence of having an imminent and aggressive cancer diagnosis among this gendered population. To add to this understanding, this study examined perceptions, beliefs, and engagement in early detection cancer behavior in a sample of Black males 23-63 years of age. nMaterials and Methods: Participants (N=312) responded to survey items assessing knowledge, beliefs, and perceptions of cancer, early cancer detection behavior, illness attitude, masculinity, attachment style, and demographic characteristics via a Qualtrics link published on Amazon MTurk. Using hierarchical regression models, associations were estimated between demographic variables, social (illness attitude, identity), behavioral (masculinity, attachment) variables, and early cancer detection behavior. nResults: Data showed age (b = -.28, p<.01), education (b = -.180, p<.01), illness attitude (b = .24, p<.01), masculinity (b = -.22, p<.01), and avoidant (b = .31, p<.01) and anxious (b = -.14, p<.01) attachment being associated with early cancer detection behavior among Black males. nConclusion: Understanding the motivation for early cancer detection behaviors may begin to address the use of mechanisms, by which to ensure a timely diagnosis, of preventable cancers, among this adult population. Our findings should be useful for researchers seeking to understand why people resist beneficial health information, and for practitioners who aim to create interventions that may reduce such resistance.

Pain and Hardship Among Older Men: Examining the Buffering Effect of Medicare Insurance Coverage:

To better understand the health status of men in the United States, this study aimed to assess the association of hardship on the presence of and pain severity among men 50 years of age and older. Cross-sectional multivariate logistic regression analyses were conducted using the 2010 wave of the Health and Retirement Study (N = 3,174) to assess the association between four hardship indicators and the presence of pain and pain severity among this sample of older men. Results suggest that the association between the presence of pain and hardship was statistically significant across all four indicators: ongoing financial hardship (CI [1.05, 1.63], p < .05), difficulty paying bills (CI [1.42, 3.02], p < .001), food insecurity (CI [1.46, 3.15], p < .001), and not taking medication due to cost (CI [1.06, 1.66], p < .05), even after adjusting for all demographic factors. The associations between pain severity and ongoing financial strain (CI [1.23, 2.83], p < .01) and difficulty paying bills (CI [1.02, 3.18], p < .05) were statistically significant. Results also indicate that education was a buffer at all levels. In addition, the interactive effect of hardship and Medicare insurance coverage on pain severity was significant only for ongoing financial strain (CI [1.74, 14.33], p > .001) and difficulty paying bills (CI [1.26, 7.05], p < .05). The evidence is clear that each hardship indicators is associated with the presence of pain and across some of the indicators in pain severity among men aged 50 and older. In addition, these findings stress the importance that Medicare insurance plays in acting as a buffer to alleviate some of the hardships experienced by older men. These findings also highlight the association between the presence of pain and pain severity for the overall quality of life, health outcomes, and financial position of men in later life.

A Question of Trust: Does Mistrust or Perceived Discrimination Account for Race Disparities in Advance Directive Completion?

Abstract Background and Objectives Advance directive completion is associated with end-of-life quality indicators such as dying at home and receiving hospice care. Black older adults are less likely to complete advance directives than their white counterparts. The underlying reasons for these race disparities are not well understood. Research Design and Methods In two related studies, data from the Health and Retirement Study were used to examine whether mistrust in health care providers and/or perceived discrimination accounted for lower rates of advance directive completion by black older adults in the United States. Odds of advance directive completion were modeled using logistic regression and multiple measures of trust in health care providers and both medical and nonmedical perceived discriminatory treatment. Results In Study 1 (n = 699), controlling for medical mistrust did not reduce the gap between black and white participants’ odds of possessing advance directives. In Study 2 (n = 2,736), higher percentages of black participants reported experiencing medical and nonmedical discriminatory treatment. However, none of the measures of discrimination accounted for black participants’ lower odds of possessing advance directives. Discussion and Implications These results call into question the common assertion that mistrust in medical providers or the health care system contributes to lower rates of advance care planning by black older adults. Future research should examine the potential relationships between advance directive completion and other dimensions of discrimination.

Influence of Social and Health Indicators on Pain Interference With Everyday Activities Among Older Black and White Cancer Patients

Objective: This prospective study aimed to determine the influence social and health factors have on pain interference with everyday activities among older patients receiving outpatient treatment services from a comprehensive cancer center. Method: Participants were surveyed on questions assessing pain interference, and social (communication), health (pain severity, comorbidities), behavioral (self-efficacy, affect), and demographic characteristics. Multivariate analyses were specified to examine determinants of pain interference, with items loading on separate cluster composites: physical interference and psychosocial interference. Results: Pain severity was a significant indicator for physical interference. Similarly, pain severity, education, self-efficacy, negative affect, and communication were predictors of psychosocial interference. Discussion: Factors defining the daily lived experiences of older adults are important in providing baseline information on functional status. This emphasizes the need to rigorously examine the association between pain, and clinical and psychosocial indicators, but more importantly indicators that contribute to the patient’s ability to perform normal everyday activities.