Date of Award

2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Therese S. Richmond

Abstract

Undertreated pain can negatively influence outcomes in seriously injured patients. The current United States (US) opioid crisis has impacted prescribing practices. Concurrently, research has documented racial disparities in pain treatment for a variety of conditions, with Black patients less likely than White patients to receive pain treatment in emergency department and out-patient settings. However, research focused on differences in pain treatment among Black patients with acute injuries requiring hospitalization is lacking, as is literature that explores the factors providers consider when planning discharge pain treatment for severely injured patients. The aims of this multi-methods dissertation study were to synthesize the existing literature about the factors that impact the receipt of pain treatment by injured Black patients, to quantitatively describe the factors that predict the discharge opioid prescriptions in a cohort of seriously injured Black men, and to qualitatively explore the factors that providers take into consideration when prescribing discharge pain medications for seriously injured patients. A secondary analysis of data from the Psychological Effects of Injuries in Injured Black Men Study (ERRI) was used to describe the factors that predict discharge opioid prescriptions in a cohort of Black men hospitalized with serious injury. Injury severity, pain severity, length of stay (LOS) and self-reported substance overuse were associated with receipt of opioids at discharge. Among patients who received opioids, pain severity and LOS were associated with increasing dosages. Providers were interviewed using a semi-structured interview guide to explore the factors that they take into consideration when planning discharge pain treatment for seriously injured patients. Providers voiced the need to determine “true” pain and described reliable methods for doing so. They expressed concern about increased risk of opioid misuse and diversion in their patient population, and discussed the consequences of not getting it right with regards to determining which patients require pain treatment. While these findings suggest that receipt of opioids in the ERRI cohort was associated with injury and pain severity, LOS, and possibly substance overuse history, provider decision-making regarding discharge opioids is complex and likely related to issues of trust, especially in the age of the current opioid crisis.

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Available to all on Thursday, September 15, 2022

Included in

Nursing Commons

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