Article

The Pain Experience of Hispanic Patients With Cancer in the United States

Eun-Ok Im

Enrique Guevara

Wonshik Chee

pain experience, Hispanic
ONF 2007, 34(4), 861-868. DOI: 10.1188/07.ONF.861-868

Purpose/Objectives: To explore Hispanic patients' cancer pain experience from a feminist perspective to find explanations for inadequate pain management.

Design: A qualitative online forum study.

Setting: Internet and community settings.

Sample:15 Hispanic patients with cancer recruited using a convenience sampling method.

Methods: A six-month online forum was conducted using nine discussion topics, and the data were processed using a thematic analysis.

Main Research Variables: Cancer pain experience.

Findings: Four major themes emerged related to the following findings. The first was a lack of communication with healthcare providers regarding undermedication. The second was that women and men were enduring pain because of traditional gender roles guiding their behaviors. Third, participants placed the highest priority on family during the diagnosis and treatment process, thus setting aside their needs for pain management. The fourth theme was that participants were enduring inconvenience and unfair treatment in the U.S. healthcare system while simultaneously appreciating the treatment they had received.

Conclusions: Because of cultural factors and marginalized status in the United States as Hispanics and as immigrants, most of the participants could not adequately describe and manage their pain.

Implications for Nursing: Findings suggest a need for further investigation of the influences of multiple factors, including financial issues, cultural norms, and gender stereotypes, on cancer pain experience among diverse subgroups of Hispanic patients with cancer.

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    References

    Anderson, K.O., Mendoza, T.R., Payne, R., Valero, V., Palos, G.R., Nazario, A., et al. (2004). Pain education for underserved minority cancer patients: A randomized controlled trial. Journal of Clinical Oncology, 22, 4918--4925.
    Anderson, K.O., Richman, S.P., Hurley, J., Palos, G., Valero, V., Mendoza, T.R., et al. (2002). Cancer pain management among underserved minority outpatients: Perceived needs and barriers to optimal control. Cancer, 94, 2295--2304.
    Ashing-Giwa, K.T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., et al. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina, and Caucasian cancer survivors. Psycho-Oncology, 13, 408--428.
    Baquet, C.R., & Commiskey, P. (2000). Socioeconomic factors and breast carcinoma in multicultural women. Cancer, 88(Suppl. 5), 1256--1264.
    Blackhall, L.J., Murphy, S.T., Frank, G., Michel, V., & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. JAMA, 274, 820--825.
    Campbell, M.K, Meier, A., Carr, C., Enga, Z., James, A.S., Reedy, J., et al. (2001). Health behavior changes after colon cancer: A comparison of findings from face-to-face and on-line focus groups. Family and Community Health, 24, 88--103.
    Campbell, R., & Wasco, S.M. (2000). Feminist approaches to social science: Epistemological and methodological tenets. American Journal of Community Psychology, 28, 773--791.
    Cleeland, C.S. (1991). Pain assessment in cancer. In D. Osoba (Ed.), Effect of cancer on quality of life (pp. 293--305). Boca Raton, FL: CRC Press.
    Cleeland, C.S., Gonin, R., Baez, L., Loehrer, P., & Pandya, K.J. (1997). Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Annals of Internal Medicine, 127, 813--816.
    Delgado, D.J., Lin, W.Y., & Coffey, M. (1995). The role of Hispanic race/ethnicity and poverty in breast cancer survival. Puerto Rico Health Sciences Journal, 14, 103--116.
    de Pheils, P.B. (2005). Colombians. In J.G. Lipson & S.L. Dibble (Eds.), Culture and clinical care (pp. 109--120). San Francisco: UCSF Nursing Press.
    de Pheils, P.B., & Jaramillo, D. (2003). Colombians. In P.F. St. Hill, J.G. Lipson, & A.I. Meleis (Eds.), Caring for women cross-culturally (pp. 108--122). Philadelphia: F.A. Davis.
    Eley, J.W., Hill, H.A., Chen, V.W., Austin, D.F., Wesley, M.N., Muss, H.B., et al. (1994). Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA, 272, 947--954.
    Fawcett, J., & Buhle, E.L., Jr. (1995). Using the Internet for data collection. An innovative electronic strategy. Computers in Nursing, 13, 273--279.
    Georgia Tech Graphics Visualization and Usability Centre. (1999). GVU's 10th WWW user survey [Online]. Retrieved June 18, 2007, fro http://www.gvu.gatech.edu/user_surveys/survey-1998-10
    Gonzalez, G., Gallardo, N.V., & Bastani, R. (2005). A pilot study to define social support among Spanish-speaking women diagnosed with a breast abnormality suspicious for cancer: A brief research report. Journal of Psychosocial Oncology, 23, 109--120.
    Guarnero, P.A. (2005). Mexicans. In J.G. Lipson & S.L. Dibble (eds.), Culture and clinical care (pp. 330--342). San Francisco, CA: UCSF Nursing Press.
    Hall, J.M., & Stevens, P.E. (1991). Rigor in feminist research. Advances in Nursing Science, 13, 16--29.
    Im, E.O. (2006). White cancer patients' perception of gender and ethic differences in pain experience. Cancer Nursing, 29, 441--450.
    Im, E.O., & Chee, W. (2004). Issues in Internet survey among cancer patients. Cancer Nursing, 27, 34--42.
    Im, E.O., Chee, W., Guevara, E., Liu, Y., Lim, H.J., Tsai, H., et al. (in press). Gender and ethnic differences in cancer pain experience: A multiethnic survey in the U.S. Nursing Research.
    Im, E.O., Lim, H.J., Clark, M., & Chee, W. (2007). African American cancer patients' pain experience. Manuscripted submitted for publication.
    Im, E.O., Liu, Y., Kim, Y., & Chee, W. (2007). Asian American cancer patients' pain experience. Manuscripted submitted for publication.
    Juarez, G., Ferrell, B., & Borneman, T. (1999). Cultural considerations in education for cancer pain management. Journal of Cancer Education, 14, 168--173.
    Lagana, K., & Gonzalez-Ramirez, L. (2003). Mexican Americans. In P.F. St. Hill, J.G. Lipson, & A.I. Meleis (Eds.), Caring for women cross-culturally (pp. 218--235). Philadelphia: F.A. Davis.
    Luquis, R.R., & Cruz, I.J.V. (2006). Knowledge, attitudes, and perceptions about breast cancer and breast cancer screening among Hispanic women residing in south central Pennsylvania. Journal of Community Health, 31, 25--42.
    Maly, R.C., Umezawa, Y., Ratliff, C.T., & Leake, B. (2006). Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients. Cancer, 106, 957--965.
    Marin, G., & Marin, B.V. (1991). Research with Hispanic populations. Newbury Park, CA: Sage.
    Marshall, P.A., Koenig, B.A., Barnes, D.M., & Davis, A.J. (1998). Multiculturalism, bioethics, and end-of-life care: Case narratives of Latino cancer patients. In J.F. Monagle & D.C. Thomasma (Eds.), Health care ethics: Critical issues for the 21st century (pp. 421--431). Gaithersburg, MD: Aspen.
    McCabe, S.E., Boyd, C.J., Couper, M.P., Crawford, S., & D'Arcy, H. (2002). Mode effects for collecting alcohol and other drug use data: Web and U.S. mail. Journal of Studies on Alcohol, 63, 755--761.
    Messias, D.K. (1996). Concept development: Exploring undocumentedness. Scholarly Inquiry of Nursing Practice, 10, 235--252.
    Messias, D.K.H. (2003). Brazilians. In P.F. St. Hill, J.G. Lipson, & A.I. Meleis (Eds.), Caring for women cross-culturally (pp. 63--77). Philadelphia: F.A. Davis.
    Morse, J.M. (1994). Designing funded qualitative research. In N.K. Denzin & Y.S. Lincoln (Eds.), Handbook of qualitative research (pp. 220--235). Thousand Oaks, CA: Sage.
    Orona, C.J., Koenig, B.A., & Davis, A.J. (1994). Cultural aspects of nondisclosure. Cambridge Quarterly of Healthcare Ethics, 3, 338--346.
    Pinquart, M., & Sorensen, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. Gerontologist, 45, 90--106.
    Rifkin, A., Doddi, S., Karagji, B., & Pollack, S. (1999). Religious and other predictors of psychosocial adjustment in cancer patients. Psychosomatics, 40, 251--256.
    Salazar, M.K. (1996). Hispanic women's beliefs about breast cancer and mammography. Cancer Nursing, 19, 437--446
    Spector, R.E. (2000). Cultural diversity in health and illness (5th ed.). Upper Saddle River, NJ: Prentice Hall Health.
    Stevens, P.E. (1996). Focus groups: Collecting aggregate-level data to understand community health phenomena. Public Health Nursing, 13, 170--176.
    Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage.
    Truell, A.D., Bartlett, J.E., II, & Alexander, M.W. (2002). Response rate, speed, and completeness: A comparison of Internet-based and mail surveys. Behavior Research Methods, Instruments, and Computers, 34, 46--49.
    U.S. Census Bureau. (2004). The Hispanic population in the United States: 2004 detailed tables. Washington, DC: Author.