An ethnographic study of factors influencing cancer pain management in South Africa

Although the knowledge exists to relieve cancer pain, inadequate pain relie f persists as an international health problem. The World Health Organizatio n has recommended a threefold strategy to improve cancer pain management: h ealth policy, drug availability, and education. Yet major barriers to effec tive cancer pain management exist in every country of the world. Effective strategies to improve pain management must be based on an understanding of the issues in individual countries. This report evaluates cultural and othe r factors influencing cancer pain management in the Republic of South Afric a. This ethnographic field study included multiple methods of data collecti on: analysis of documents, participant observation, focused interviews, and in-depth interviews of informants (n = 33) who represented multiple stakeh olders in a variety of settings. Cultural beliefs and practices form the co ntext for understanding cancer pain and how it is managed. Cultural variabi lity exists regarding cancer as a disease, pain expectations, pain toleranc e, pain expression, and health care practices. Key factors that influence h ow pain is managed included standards, knowledge, resources, communication and the patient-provider relationship, and teamwork and professional relati onships. The existence of these factors promotes effective pain management, whereas their absence creates a barrier to achieving this aim.