University of Missouri School of Medicine MU Health School of Medicine
News Divider
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

MU Health Magazine


News and Events

David Chang Grill with Caution
Wire bristles from barbecue brushes can cause serious injuries
Tahir Rahman Extreme Beliefs Often Mistaken for Insanity, New Study Finds
Researchers say new term offers more precise definition of non-psychotic behaviors
Paul Tatum Family Medicine Professor Wins Distinguished Physician Award
Tatum recognized for outstanding care of patients near the end of life
Seth Sherman Minimally Invasive Tendon Repair Technique Supports Knee Movement Sooner after Surgery
Researchers found suture anchors, a less-invasive repair technique, responded better to strength-testing after surgery
2016 Graduation MU School of Medicine Awards 86 Medical Degrees at Commencement Ceremony
The graduates will go on to receive additional training as resident physicians in their chosen specialties
Patrice Delafontaine MU School of Medicine Dean Inducted into Prestigious Medical Society
Delafontaine joins elite group of physicians in American Clinical and Climatological Association
Steven Zweig MU Family Medicine Ranked Among Nation’s Best by U.S. News & World Report
Department has been in top 10 for 23 consecutive years
Uzma Khan MU Initiative Helps Rural Doctors Treat Chronic Pain
Show-Me ECHO to offer special training session April 28
Legacy Teachers MU School of Medicine Program Expands to Other Medical Schools
MU’s Legacy Teachers program lets students recognize patients as educators
Susan Nagel Oil and Gas Wastewater Disposal May Increase Endocrine Disrupting Activity
Scientists draw conclusions after study at natural gas and oil extraction wastewater disposal facility
St. Baldricks 2016 Participants Go Bald for Childhood Cancer Research
Community donates more than $40,000 to the cause

Media Relations
University of Missouri Health System
One Hospital Drive, DC028.00
Columbia, MO 65212
24/7 on-call pager: (573) 876-0708

Mary Jenkins
(573) 882-7299

Jeff Hoelscher
(573) 884-1608

Derek Thompson
(573) 882-3323

Diamond Dixon
(573) 884-7541

Justin Kelley (Photographer)
(573) 882-5786
Pager (573) 397-9289

Web Communications
University of Missouri Health System
One Hospital Drive, MA204G, DC018.00
Columbia, MO 65212
(573) 884-0298

Jennifer Orford
(573) 882-0298

Deidra Ashley
(573) 884-3988

Jesslyn Chew
(573) 884-2891

Velvet Hasner
(573) 884-1115

Justin Willett
(573) 884-7740

Printer Friendly
Follow us on Twitter!   Facebook   YouTube Videos   Instagram   Pinterest  
Website created and maintained by the Office of Communications. Contact the MU School of Medicine.
Revised: July 23, 2015 - Copyright © 2014 - Curators of the University of Missouri. All rights reserved. DMCA and other copyright information. An equal opportunity/access/affirmative action/pro-disabled and veteran employer.