HISPANIC LATINOS' PERSPECTIVES ON CANCER PAIN: BARRIERS TO RELIEF
Background and Rationale: In spite of expanding treatment options, increasing knowledge about pain physiology, professional educational efforts, and the dissemination of national and international professional treatment guidelines, many persons with cancer continue to experience unacceptable levels of pain. Under-treatment of CRP negatively impacts many domains of life, often affecting families, communities, and society. Forces at work at the individual, provider, institution and societal levels converge as they contribute to CRP. Additional contributing factors include the cultural context and beliefs about pain, meaning of pain, barriers to pain relief, and shared expectations about pain expression that are seldom acknowledged or explored in clinical encounters. Little research has looked at dimensions of CRP among New Mexican Hispanic/Latinos as a cultural group and external factors that intersect with these experiences.
Methods: Using a qualitative descriptive design, interviews with Hispanic/Latinos having CRP aimed to elicit perceptions of how external factors, such as interactions with the healthcare system and providers, contributed to their experience. Secondary data came from allopathic physicians, a traditional folk healer (curandera), and family caregivers. Interviews were digitally recorded and independently transcribed. To triangulate findings, medical records were reviewed for aspects of documentation of pain assessment and management. Data were analyzed using thematic analysis.
Results: Fourteen Hispanic/Latino adults with CRP participated in individual interviews, as did three family caregivers and three healthcare providers. The theme, Hurdles and Hindrances, largely described barriers to pain relief. Participants identified gaps in pain assessment and challenges related to accountability for who was managing their pain. Deficits in provider communication and being treated with respect and believed about their pain were also described. A final element to this theme reflected misconceptions and medication side effect management. Participants suggested that providers situate pain within the context of the whole person, treat them with respect, acknowledge the importance of family inclusion, and strive for better patient – provider communication. Medical record reviews found little use of evidence-based guidelines in assessment and treatment of CRP among these participants. Family members described a need to advocate on behalf of their loved ones, reinforcing the challenges with pain assessment and management described by the primary participants.
Implications: These findings align with past research and suggest a shift in the provider-centric paradigm, instead creating a patient/family centered model. Greater inclusivity supports development of a trusting provider/patient/family triad. Improving communication creates a platform for achieving a more complete understanding of the experience, thus informing management, improving patient/provider relationships, and the quality of care provided. Recommendations for professionals and institutions include developing clearer accountability for direct pain management as patients’ transition between providers and specialties, as well as creating a stronger infrastructure to support communication and delivery of evidence-based practices and quality metrics to evaluate pain care.