Article

Barriers to Pain Management in a Community Sample of Chinese American Patients with Cancer

School of Nursing, University of California at San Francisco, California, USA.
Journal of pain and symptom management (Impact Factor: 2.74). 12/2008; 37(4):665-75. DOI: 10.1016/j.jpainsymman.2008.04.014
Source: PubMed

ABSTRACT Barriers to cancer pain management can contribute to the undertreatment of cancer pain. No studies have documented barriers to cancer pain management in Chinese American patients. The purposes of this study in a community sample of Chinese Americans were to: describe their perceived barriers to cancer pain management; examine the relationships between these barriers and patients' ratings of pain intensity, pain interference with function, mood disturbances, education, and acculturation level; and determine which factors predicted barriers to cancer pain management. Fifty Chinese Americans with cancer pain completed the following instruments: Brief Pain Inventory (BPI), Karnofsky Performance Status (KPS) Scale, Barriers Questionnaire (BQ), Hospital Anxiety and Depression Scale (HADS), Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a demographic questionnaire. The mean total BQ score was in the moderate range. The individual barriers with the highest scores were: tolerance to pain medicine; time intervals used for dosage of pain medicine; disease progression; and addiction. Significant correlations were found between the tolerance subscale and least pain (r=0.380) and the religious fatalism subscale and average pain (r=0.282). These two subscales were positively correlated with anxiety and depression levels: (tolerance: r=0.282, r=0.284, respectively; religious fatalism: r=0.358, r=0.353, respectively). The tolerance subscale was positively correlated with pain interference (r=0.374). Approximately 21% of the variance in the total BQ score was explained by patients' education level, acculturation score, level of depression, and adequacy of pain treatment. Chinese American cancer patients need to be assessed for pain and perceived barriers to cancer pain management to optimize pain management.

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    • "Asian and Spanish-speaking Latina patients report higher barrier questionnaire scores compared to Western patients, but not Afro-Americans.[815] Patients who perceive high barriers to pain management underuse analgesics[2122] and this may explain the high prevalence of undertreated cancer pain among American Asian cancer patients.[23] Black patients in the USA are significantly less likely to have their pain recorded, and a similar non-significant trend is noted in other ethnic groups despite adjustment for language differences.[14] "
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    ABSTRACT: Background: Cancer pain is a complex multidimensional construct. Physicians use a patient-centered approach for its effective management, placing a great emphasis on patient self-reported ratings of pain. In the literature, studies have shown that a patient's ethnicity may influence the experience of pain as there are variations in pain outcomes among different ethnic groups. At present, little is known regarding the effect of ethnicity on the pain experience of cancer patients; currently, there are no systematic reviews examining this relationship. Materials and Methods: A systematic search of the literature in October 2013 using the keywords in Group 1 together with Group 2 and Group 3 was conducted in five online databases (1) Medline (1946–2013), (2) Embase (1980–2012), (3) The Cochrane Library, (4) Pubmed, and (5) Psycinfo (1806–2013). The search returned 684 studies. Following screening by inclusion and exclusion criteria, the full text was retrieved for quality assessment. In total, 11 studies were identified for this review. The keywords used for the search were as follows: Group 1-Cancer; Group 2- Pain, Pain measurement, Analgesic, Analgesia; Group 3- Ethnicity, Ethnic Groups, Minority Groups, Migrant, Culture, Cultural background, Ethnic Background. Results: Two main themes were identified from the included quantitative and qualitative studies, and ethnic differences were found in: (1) The management of cancer pain and (2) The pain experience. Six studies showed that ethnic groups face barriers to pain treatment and one study did not. Three studies showed ethnic differences in symptom severity and one study showed no difference. Interestingly, two qualitative studies highlighted cultural differences in the perception of cancer pain as Asian patients tended to normalize pain compared to Western patients who engage in active health-seeking behavior. Conclusion: There is an evidence to suggest that the cancer pain experience is different between ethnicities. Minority patients face potential barriers for effective pain management due to problems with communication and poor pain assessment. Cultural perceptions of cancer may influence individual conceptualization of pain and affect health-seeking behavior.
    Indian Journal of Palliative Care 09/2014; 20(3):194-200. DOI:10.4103/0973-1075.138391
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    • "This can lead to a considerable number of misconceptions and myths regarding pain management. For example, healthcare providers (physicians and nurses mainly) erroneously believe that taking narcotics means addiction in cancer patients (Edrington et al., 2009, Finley et al., 2008, David et al., 2003, Beck, 2000). Further, nurses in Jordan have been found to have a weak knowledge of pharmacological pain treatment (e.g., correct dosage, duration of effect, drug rotation), the preferred rout of administration, and fear of addiction (Al Qadire & Al Khalaileh, 2012). "
    Palliative Care to the Cancer Patient: The Middle East as a Model for Emerging Countries, Edited by Silbermann, M, 02/2014: chapter Palliative care in Jordan: accomplishments and challenges: pages In press; NOVA SCIENCE PUBLISHERS.
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    • "Several patient characteristics have been associated with attitudes that may result in more barriers to the use of analgesic medications (i.e., higher attitudinal barriers) including non-White race, lower education, more physical symptoms [10], older age [11], higher pain severity and disability [12], unemployment [13], and depression [14], while the data on gender are mixed [13, 15]. Other characteristics have not been explored but seem likely to impact attitudinal barriers, such as whether patients are currently or previously addicted to substances, the substances to which they may be addicted (e.g., opioids versus nonopioid drugs), and recent use of analgesics. "
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    ABSTRACT: Attitudinal barriers towards analgesic use among primary care patients with chronic pain and substance use disorders (SUDs) are not well understood. We evaluated the prevalence of moderate to significant attitudinal barriers to analgesic use among 597 primary care patients with chronic pain and current analgesic use with 3 subscales from the Barriers Questionaire II: concern about side effects, fear of addiction, and worry about reporting pain to physicians. Concern about side effects was a greater barrier for those with opioid use disorders (OUDs) and non-opioid SUDs than for those with no SUD (OR (95% CI): 2.30 (1.44-3.68), P < 0.001 and 1.64 (1.02-2.65), P = 0.041, resp.). Fear of addiction was a greater barrier for those with OUDs as compared to those with non-opioid SUDs (OR (95% CI): 2.12 (1.04-4.30), P = 0.038) and no SUD (OR (95% CI): 2.69 (1.44-5.03), P = 0.002). Conversely, participants with non-opioid SUDs reported lower levels of worry about reporting pain to physicians than those with no SUD (OR (95% CI): 0.43 (0.24-0.76), P = 0.004). Participants with OUDs reported higher levels of worry about reporting pain than those with non-opioid SUDs (OR (95% CI): 1.91 (1.01-3.60), P = 0.045). Concerns about side effects and fear of addiction can be barriers to analgesic use, moreso for people with SUDs and OUDs.
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