Project

The role of ethnicity in opioid prescribing and health service use in the last three months of life: a population-based comparative cohort study of cancer patients-PEOLC23

Background

Many people with advanced cancer experience horrible pain. When health professionals ask people about their pain and treat it, improvements are seen. Studies, mostly from the USA, show people with advanced cancer from Black, Asian and ethnically diverse (BAED) groups are sometimes prescribed fewer painkillers than others. This means many remain in pain. In the UK, we know from yearly surveys that people with cancer from BAED groups are unhappy with how their pain is treated compared to others. Our two BAED PPI members helped us find other people with cancer from BAED backgrounds or bereaved relatives of loved ones who died from cancer. They shared upsetting stories about how their pain was managed. However, in the UK no research has examined if people with cancer from BAED groups are prescribed fewer painkillers that white people at the end of life. Without answers, it's impossible to know where or what changes are needed.

What is this study planning to do?

We want to study, for the first time in the UK, the painkillers prescribed to people with cancer at the end of life to find out if there are differences by ethnic group.

What we will do

With our PPI members, we will study databases called the Clinical Practice Research Datalink and Hospital Episode Statistics. They contain anonymised information for millions of people about their ethnicity, illnesses, GP visits, hospital and A&E admissions and medicines, including cancer painkillers. With these data, we will be able to find people with advanced cancer and which painkillers were prescribed to them. We will work out if there are differences in the type and number of painkillers prescribed to people from different BAED groups, along with other reasons that might explain this.

Sharing what we learn and future work

This study will find out if more or fewer painkillers are prescribed to people with cancer at the end of life from different ethnic groups in all settings (home, care homes, hospitals and hospices). With our PPI members, we will share what we find in a medical journal and YouTube for health professionals locally and nationally so they can learn and improve their care. This study will lead to a ‘path to change’ improving understanding of prescribing cancer painkillers across different ethnic groups. Future work will include talking with people with advanced cancer from BAED backgrounds and especially those groups where we find that fewer painkillers have been prescribed than expected. We will also talk with health professionals about how they talk about and manage cancer pain among people from BAED backgrounds, especially those where we find fewer painkillers have been prescribed than expected, so we can find solutions that make a difference.

Researchers and institutions

Koffman J, Wei G, Bajwah S, Barclay S, Kumar R, Richardson G, Wanklyn S