New Mexican hispanic latinos' perspectives on cancer pain: meaning, coping, and barriers to relief

The primary aim of this qualitative descriptive study was to explore the experience of cancer-related pain (CRP) among Hispanic/Latino adults in New Mexico, and secondarily to describe how institutional and provider-level factors influence the personal experience of CRP. Fourteen individual interviews were recorded and independently transcribed. To triangulate findings additional data came from interviews with two allopathic physicians, a traditional folk healer (curandera), and three family caregivers; medical records were reviewed for evidence of pain assessment and management. Thematic analysis guided the formation of three primary themes and associated categories. Pain Is More Than Physical captured aspects of pain beyond a physical experience, including meaning, ways pain was described and the critical need for building trusting relationships with providers. Coping with Pain encompassed participants' strategies for managing pain, inclusive of culturally-learned behaviors. Of importance was family support and faith in dealing with pain. The theme, Hurdles and Hindrances, reflected barriers to pain relief. Gaps in pain assessment and challenges related to accountability for who was managing the pain were identified. Deficits in provider communication and being treated with respect were described. A final element to this theme reflected misconceptions and medication side effect management. Medical record analysis found limited use of evidence-based guidelines in pain assessment and management. Participants suggested that providers situate pain within the context of the iv whole person and family experience and strive for better patient-provider communication. Family members described needing to advocate for their loved ones, reinforcing the challenges with pain assessment and management described by participants. These findings align with past research and suggest a shift in the providercentric 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 a better understanding of the patient/family experience and how behavior and coping is shaped by culture, thus informing management and the quality of care. Further recommendations for professionals and institutions are developing clearer accountability for pain management as patients' transition between specialist-providers, as well as creating a stronger infrastructure to support communication and delivery of evidence-based practices and quality metrics to evaluate pain care.