INFLUENCE OF CULTURE ON CANCER PAIN MANAGEMENT IN HISPANIC PATIENTS

PURPOSE: The purpose of this pilot study was to describe the influence of Culture on cancer pain management ill Hispanic (Mexican and Centra l American) patients. DESCRIPTION OF STUDY: This qualitative study is guided by the conceptual framework of the Pain and Quality of life mod el and the Biocultural Model of Pain. It was developed as a companion study to a National Cancer Institute (NCI)-funded project to dissemina te a pain education program for adult patients with cancer and their f amily care givers in community home-care agencies. After completing th e NCI study, Hispanic subjects were invited to participate in the qual itative companion study. A total of 17 subjects, the majority of whom were women, were interviewed, The Hispanic Pain Experience Questionnai re (HPEQ) was used to elicit answers to open-ended questions regarding the perception and management of cancer pain, RESULTS: Themes that em erged from the questionnaire were Influence of Culture, Expressions of Pain, Managing Pain/Medications, and Use of Nondrug Interventions, Re sponses 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 dem onstrated a reliance on folk beliefs and nondrug interventions. The mu st common reason cited for noncompliance with pharmacologic treatment was an inability to understand instructions. CLINICAL IMPLICATIONS: Wh en providing care to Hispanic patients, it is imperative to be nonjudg mental, sensitive, and respectful. To improve compliance, the multidis ciplinary cancer team should 1) incorporate the patients' folk healthc are practices and beliefs into the plan of care when possible; 2) invo lve family members and friends in the patient's care, identifying one key family contact; and 3) ensure that instructions for medications ar e available in Spanish and understood by the patient and care giver. W hen patients; overall beliefs and values are respected: compliance wit h pharmacological and other interventions may increase accordingly.