Influence of Culture on Cancer Pain Management in Hispanic Patients

Abstract

PURPOSE: The purpose of this pilot study was to describe the influence of culture on cancer pain management in Hispanic (Mexican and Central American) patients. DESCRIPTION OF STUDY: This qualitative study is guided by the conceptual framework of the Pain and Quality of Life model and the Biocultural Model of Pain. It was developed as a companion study to a National Cancer Institute (NCI)-funded project to disseminate a pain education program for adult patients with cancer and their family care givers in community home-care agencies. After completing the NCI study, Hispanic subjects were invited to participate in the qualitative companion study. A total of 17 subjects, the majority of whom were women, were interviewed. The Hispanic Pain Experience Questionnaire (HPEQ) was used to elicit answers to open-ended questions regarding the perception and management of cancer pain. RESULTS: Themes that emerged from the questionnaire were Influence of Culture, Expressions of Pain, Managing Pain/Medications, and Use of Nondrug Interventions. Responses suggest that culture, family beliefs, and religion contribute significantly to management and expression of pain by the patient and care giver. In addition, this group showed that pain may be approached with stoicism; therefore, lack of verbal or behavioral expression of pain does not indicate a lack of pain itself. These patients also demonstrated a reliance on folk beliefs and nondrug interventions. The most common reason cited for noncompliance with pharmacologic treatment was an inability to understand instructions. CLINICAL IMPLICATIONS: When providing care to Hispanic patients, it is imperative to be nonjudgmental, sensitive, and respectful. To improve compliance, the multidisciplinary cancer team should 1) incorporate the patients' folk healthcare practices and beliefs into the plan of care when possible; 2) involve family members and friends in the patient's care, identifying one key family contact; and 3) ensure that instructions for medications are available in Spanish and understood by the patient and care giver. When patients' overall beliefs and values are respected, compliance with pharmacological and other interventions may increase accordingly.