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Karla Washington and Nidhi Khosla
In a recent study published in the American Journal of Hospice and Palliative Medicine, Nidhi Khosla, PhD, left, and Karla Washington, PhD, examined the perspective of health care providers on U.S. South Asians’ attitudes to pain management during end-of-life care.


U.S. South Asians More Reluctant to Seek Medication for Pain


Health care workers should be culturally aware when caring for patients, families from the South Asian region

When compared with other ethnicities, Asians are the most unsatisfied with the health care they received in the United States, previous research has shown. This dissatisfaction with health care partly is caused by health practices in the U.S. clashing with the practices Asian patients and families may be more used to experiencing overseas. Now, researchers at the University of Missouri have found that health care providers perceive South Asians living in the U.S. to be more reluctant than other ethnicities to report pain as well as seek medications to treat the pain they experience near the end of their lives. Researchers say this finding provides an opportunity for health care professionals to deliver better culturally responsive care to South Asian patients and their families.

“In future years, health care workers in the U.S. will provide care to an increasingly diverse group of patients that will include growing numbers of South Asians,” said Karla Washington, PhD, assistant professor in the Department of Family and Community Medicine at the MU School of Medicine and co-author of the study. “It is important to understand the cultural differences in medical practice in South Asia, such as their low use of pain medication, so that health care providers here can better understand the factors that influence their patients’ attitudes toward pain medicines.”

Washington and her colleague Nidhi Khosla, PhD, assistant professor in the Department of Health Sciences at the MU School of Health Professions and lead author of the study, conducted focus groups and individual interviews with health care professionals who had experience providing care to seriously ill South Asian patients and their families. Health care providers told Khosla and Washington that they perceived South Asian patients to have minimalistic attitudes toward medication in general. Further, South Asians may have prior experiences having limited access to pain medication overseas.

“Doctors in South Asia do not routinely ask patients about their pain like they do here,” Khosla said. “In South Asian culture, it is common for patients not to report their pain to avoid burdening others or being seen as weak.”

Khosla said in the U.S., health care providers typically ask patients to rank their pain from one to 10. Those pain scales are not used in South Asia, and people from that region may not be accustomed to discussing pain in that way. In addition, Khosla said participants in the study revealed it is not uncommon for patients in South Asia to be given low-dose pain medications such as Tylenol after surgeries like Cesarean sections and gallbladder removals, which is a stark contrast to the narcotic medications typically prescribed here after similar procedures.

“When treating patients from this region, doctors should consider asking about their unique values and preferences,” Washington said. “Chaplains and social workers also can help facilitate communication between patients and doctors about medications and alternative treatment options that could be more aligned with patients’ spiritual and cultural needs.”

Washington said many South Asian patients and families in this country spent a considerable amount of time living in South Asia, and their experiences with medicines there influence their attitudes about medicine here.

Among Asians, South Asians are a culturally similar group with origins in India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan and Maldives. In 2010, the United States Census reported 3.8 million South Asians were living in the U.S., an increase of more than 80 percent since 2000. In addition, approximately 75 percent of South Asians living in the U.S. were born in a country other than the U.S., with the vast majority having been born in the South Asia region.

The study, “Perspectives of Health Care Providers on U.S. South Asians’ Attitudes Toward Pain Management at End of Life,” recently was published in the American Journal of Hospice and Palliative Medicine and was funded by the University of Missouri Alumni Association’s Dr. Richard Wallace Faculty Incentive Grants program. Hariharan Regunath, MD, a critical care fellow at the MU School of Medicine’s Division of Pulmonary and Critical Care Medicine, is the third author of the study.

Click here for a high-resolution photo of Nidhi Khosla, PhD, and Karla Washington, PhD.
Click here for a high-resolution photo of Nidhi Khosla, PhD.
Click here for a high-resolution photo of Karla Washington, PhD.

Posted July 23, 2015




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