Table 2.
Crosstabulation illustrating summary of all included studies (N = 46)
| No | First author Country Year |
Study population and (N) | Ethnic groups1 (%)2 | Disease groups | Setting | Summary method and aims | WoE3 |
|---|---|---|---|---|---|---|---|
| 1 |
Anderson USA 2000 [88] |
Patients (108) Clinicians (55) |
Patients: African American (41%) Hispanic (59%) Clinicians: White (68%) African American (17%) Asian/ Pacific Islander (11%) Other (4%) |
Cancer | Hospital—outpatients | Patient questionnaire survey to determine pain needs, including pain measures and PROMs. Clinician survey on pain management to determine attitudes | H |
| 2 |
Anderson USA 2002 [89] |
Patients (31) |
African American (45%) Hispanic (55%) |
Cancer | Hospital – outpatient oncology clinic | Qualitative structured interview with pain measure rating to explore barriers to pain management | H |
| 3 |
Bell USA 2011 [90] |
Patients (4,658) |
White (43%) Asian (34%) Hawaiian/Pacific Islander (18%) Other (5%) |
Cancer | Hospital—inpatient | Clinical data analysis including pain measures, to examine ethnic disparities in pain outcomes after palliative care consultations | H |
| 4 |
Booker USA 2020 [91] |
Patients (64) |
African American (50%) Caucasian (50%) |
Cancer | Hospice—inpatient | Secondary matched data analysis examining ethnic differences. Data drawn from an RCT of cancer pain management interventions | H |
| 5 |
Green USA 2009 [92] |
Patients (96) |
White (71%) Black (21%) Native American (4%) Hispanic (3%) Arabic (2%) Black/Native American (1%) |
Cancer | Hospital—outpatient | Longitudinal cohort pain survey to examine ethnic differences. Including PROMs and pain measures at 3 time points | H |
| 6 |
Koffman UK 2008 [128] |
Patients (45) |
Black Caribbean (58%) White British (42%) |
Cancer | Hospital inpatient, outpatient, community palliative care | Semi-structured qualitative interview to examine ethnic meanings attributed to cancer pain | H |
| 7 |
Laguna USA 2014 [93] |
Patients (385) |
White (46%) Black (25%) Latino (29%) |
Cancer Heart Failure Heart Disease Dementia |
Hospital – from inpatient to outpatient | Longitudinal study of pain consultation intervention to examine ethnic differences, with data collected at 4 time points | H |
| 8 |
Lamba USA 2020 [94] |
Patients (17,957) |
White (75%) African American (11%) Hispanic (7%) Asian (7%) |
Cancer—Brain metastases | All – Medicare data | Retrospective analysis of data to evaluate prevalence of medication utilisation, and assess potential racial disparities in prescriptions of such medications | H |
| 9 |
McGrath Australia 2006 [131] |
Patients (10) Carers (19) Aboriginal health workers (11) Healthcare professionals (30) Interpreter (2) |
Aboriginal (100%) | Not reported | Community | Qualitative semi-structured interviews to explore and document issues associated with pain management for Aboriginal people | H |
| 10 |
Wilkie USA 2017 [96] |
Patient-Caregiver dyads (161) |
Patients: Caucasian (49%) African Amer (34%) Asian Amer (< 1%) Other (13%) Multi-race (2%) Unknown (1%) |
Cancer | Home hospice care | Cross-sectional study of pain management barriers, data from an RCT of home hospice | H |
| 11 |
Anderson USA 2004 [97] |
Patients (97) |
African American (43%) Hispanic (57%) |
Cancer | Hospital—outpatient | RCT of pain management education intervention, including PROMs and pain measures. Evaluation of the efficacy for minority patients | M |
| 12 |
Carter USA 2006 [98] |
Physicians (40) |
African American (60%) Caucasian (40%) |
All EOL care | Primary care, oncology, cardiology | Semi-structured interview examining physicians’ perceptions of patients’ preferences, comprising quantitative and qualitative components | M |
| 13 |
Cea USA 2016 [99] |
Patients (3,918) |
Non-Hispanic White (84%) Non-Hispanic Black (11.1%) Hispanic (3%) Other race/ethnicity (2%) |
Cancer and non-cancer | Hospice discharge of home health and hospice | Secondary analysis of national hospice survey data, examining pain assessments, management and outcomes | M |
| 14 |
Check USA 2016 [100] |
Patients (883) |
White (85%) Black (15%) |
Cancer | All settings – Medicare data | Retrospective analysis of Medicare data to examine ethnic disparities | M |
| 15 |
Chung USA 2016 [101] |
Patients (161) |
African American (9%) Asian/Other (9%) Caucasian (48%) Hispanic/Latino (33%) |
Cancer COPD Heart Failure Liver Failure Organ failure |
Hospital – inpatient | Retrospective clinical data analysis, including pain measures, to examine ethnic disparities | M |
| 16 |
Edrington USA 2009 [102] |
Patients (50) | Chinese American (100%) | Cancer | Hospital—outpatient | PROMs questionnaire survey with pain measures examining barriers to pain management | M |
| 17 |
Fisch USA 2012 [103] |
Patients (3,123) (2,026 in analysis) |
In analysis White (77%) Hispanic/Latino (9%) Black (12%) Asian (1%) Other minority (1%) |
Cancer | Hospital—outpatient | Prospective study of pain, symptoms and prescribing, with pain measurements at two time points | M |
| 18 |
Fischer USA 2007 [117] |
Patients (217) |
African American (13%) White (68%) Hispanic White (9%) Other (1%) Unknown (10%) |
Cancer | Hospital—inpatient | Retrospective analysis of clinical data from veterans’ hospital to determine ethnic differences in EOL care | M |
| 19 |
Gerlach USA 2021 [104] |
Patients (554,022) |
Non-Hispanic White (88%) Non-Hispanic Black (8%) Hispanic (2%) |
Cancer Heart disease Dementia, Respiratory disease Stroke |
Hospices | Prevalence study of class-specific psychotropic and opioid prescriptions | M |
| 20 |
Gurney New Zealand 2021 [132] |
Patients (20,081) |
Māori (20%) Non- Māori (80%) |
Lung cancer | All – New Zealand Cancer Registry data | Retrospective analysis of data to describe access (and timing of access) to pain medications | M |
| 21 |
Hwang USA 2004 [105] |
Patients (89) |
Caucasian (57%) African American (43%) |
Cancer | Hospital | Retrospective data analysis of palliative care resource use in prostate cancer patients | M |
| 22 |
Khosla USA 2016 [106] |
Clinicians and healthcare providers (57) |
South Asian (39%) Not South Asian (61%) |
All EOL care | Healthcare systems, community, hospice and private practice | Qualitative interviews and focus groups on South Asian patients’ preferences | M |
| 23 |
Koffman UK 2003 [129] |
Family members and friends of patients (69) |
Patients: Black Caribbean (49%) UK-born White (51%) |
Cancer | Home or hospital death of patients | Structured questionnaire interview on patients’ symptoms before death | M |
| 24 |
Kwon USA 2013 [107] |
Patients (196) |
White (75%) Black (15%) Hispanic (7%) Other (3%) |
Cancer | Hospital—outpatients | Secondary analysis of data from an observational cohort study to examine barriers to pain management, including PROMs and opioid adherence data | M |
| 25 |
Meghani USA 2021 [108] |
Patients (32) |
White (50%) African American (50%) |
Cancer | National Cancer Institute | Qualitative, semi-structured interviews to describe cancer patients’ concerns while undergoing cancer treatment, and determine if concerns differ between African Americans and Whites | M |
| 26 |
Mosher USA 2010 [109] |
Patients (87) |
African American (17%) Spanish speaking Latina (31%) English speaking Latina (11%) Caucasian (31%) |
Cancer | Hospital—outpatient | PROMs questionnaire survey to examine the relationship between self-efficacy for coping and pain management/distress | M |
| 27 |
Nedjat-Haiem USA 2012 [100] |
Patients (24) | Latina (100%) | Cancer with depression | Medical centre—outpatient | Qualitative interview on Latin American patients’ sociocultural beliefs and health care, part of a wider RCT intervention on cancer and depression | M |
| 28 |
Pinheiro USA 2019 [111] |
Patients (23,091) |
USA born non-Hispanic (88%) USA born Hispanic (4%) Non-USA born Hispanic (6%) Foreign born Hispanic (2%) |
Cancer | All – National cancer and Medicare data | Secondary data analysis of cancer registry and Medicare data examining ethnic differences in breast cancer patients’ medication use | M |
| 29 |
Rabow USA 2005 [95] |
Patients (90) |
Asian/Pacific islander (12%) Black/African American (18%) Latino (10%) White/Caucasian (53%) Other (7%) |
Cancer COPD Heart Failure |
Hospital—outpatient | Cohort study within a controlled trial of a palliative care consultation, including exploration of ethnic differences | M |
| 30 |
Reynolds USA 2008 [112] |
Patients (1,133) |
White (77%) Minority (23%) |
Dementia Stroke/CVA Heart Failure Diabetes COPD Cancer |
Nursing homes | Observational cohort study. Clinical chart review of nursing home residents’ data to identify differences in end of life care | M |
| 31 |
Rhodes USA 2007 [113] |
Proxies of decedents (98,911) |
Non-Hispanic Black (4%) Non-Hispanic White (96%) |
Cancer, Dementia Heart disease Lung disease Frailty/Old age Other |
Hospices | Survey design to examine whether racial differences in perceived care exist | M |
| 32 |
Zapka USA 2006 [114] |
Patients and race-matched physician for interview (90) |
Caucasian (43%) African American (57%) |
Cancer Heart Failure |
Hospital – outpatient and primary care | Cross-sectional structured interview study using race-matched physicians interviewing patients on the topic of communication | M |
| 33 |
Burgio USA 2016 [115] |
Patients (6,066) |
White (65%) African American (35%) |
Cancer Dementia Lung Disease Heart Disease Kidney Disease Liver Disease Stroke HIV |
Hospital—inpatient | Secondary data analysis of education intervention trial. Data collected after death to examine processes of care at EOL and ethnic differences | L |
| 34 |
Campbell USA 2013 [85] |
Patients, family members or caregivers (743) |
Survey respondents: White (85%) African American (12%) Other (3%) |
Cancer and non-cancer | Hospice – inpatient and community | Questionnaire survey to measure satisfaction with hospice services by patient/family ethnicity | L |
| 35 |
Dhingra USA 2011 [116] |
Patients (170) | Chinese American (100%) | Cancer | Private community-based oncology centre—outpatients | Describing the epidemiology of pain in Chinese Americans using clinical data analysis and PROMs measures questionnaire survey | L |
| 36 |
Halpern USA 2019 [118] |
Patients (8,438) |
Non-Hispanic white (53%) Non-Hispanic black (21%) Hispanic (13%) Other/unknown (13%) |
Cancer | All – Medicaid data | Retrospective analysis of Medicaid data examining pain management, state policy and patient characteristics | L |
| 37 |
Kalauokalani USA 2007 [119] |
Patients (67) |
White (78%) Latino (9%) Asians (6%) Black (3%) Other (4%) |
Cancer | Hospital—outpatient | Secondary data analysis of RCT examining whether patient coaching can reduce ethnic equalities in pain | L |
| 38 |
Kypriotakis USA 2014 [120] |
Patients (196) |
Black (33%) White (66%) |
Cancer | Hospital—outpatient | Secondary data analysis examining ethnicity and preferences for care. Data drawn from RCT of coping and cancer intervention | L |
| 39 |
Monroe USA 2010 [127] |
Patients (55) |
African American (29%) Caucasian (71%) |
Dementia with cancer | Nursing home resident | Retrospective data review to examine ethnic differences in pain management at the end of life. | |
| 40 |
Patel USA 2020 [121] |
Patients (142) (43 for sub study) |
White (63%) Black (35%) |
Cancer | Clinic—outpatient | Quasi-experimental study assessing the impact of clinical pharmacy assessments with and without pharmacogenomics | L |
| 41 |
Rhodes USA 2012 [122] |
Bereaved family members (11,892) |
Deceased patients: African American (100%) |
Cancer Dementia Heart Disease Lung Disease Frailty/ Old Other |
Hospice | Secondary analysis of national survey data comparing family members’ perceptions of care with the proportion of African-Americans at hospice | L |
| 42 |
Rolnick USA 2007 [123] |
Patients (421) |
White (83%) African American (8%) Asian (4%) Hispanic (4%) Native American (< 1%) |
Ovarian cancer | Hospital | Retrospective analysis to report on medication use for pain management during the last six months of life | L |
| 43 |
Sadler UK 2009 [130] |
Patients (244) In analysis: (231) |
Caucasian (70%) Black (14%) Asians (10%) Not included in analysis: Chinese (1%) Unknown (4%) |
Cancer | Hospital | Retrospective clinical audit examining influence of ethnicity on presentation, symptomatology and outcomes in oesophageal cancer | L |
| 44 |
Saphire USA 2020 [124] |
Patients (16,246) |
White (81%) Black (8%) Hispanic (5%) Asian (6%) |
Lung cancer | Hospital—outpatients | Retrospective cohort study using data to examine patterns of symptom management medication receipt at EOL | L |
| 45 |
Strassels USA 2006 [125] |
Patients (347,555) (156,887 included in pain analysis) |
Asian or Pacific Islander (1%) African American (5%) Hispanic or Latino (2%) Native Amer (< 1%) Caucasian (54%) Other (< 1%) Missing (38%) |
Cancer Heart Disease COPD Unspecified |
Hospice | Retrospective analysis of national clinical and administrative data to describe demographics, clinical characteristics, and pain intensity of persons who received hospice care | L |
| 46 |
Wieder USA 2014 [126] |
Patients (360) |
African American (48%) Hispanic (33%) Caucasian (13%) Not included in analysis Asian (5%) Not specified (2%) |
Cancer | Hospital – inpatient, outpatient and emergency depart | Clinical data review to examine prescription coverage and the prescribing of long-acting opiates to minority patients with cancer pain | L |
1Ethnic and racial group names as stated in original paper
2Rounded to 0 decimal places
3WoE Gough’s Weigh of Evidence Framework. Category D – total score. H Higher, M Medium, L Lower