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Shinjo SK, Kim M, Hoff LS, Missé RG, Sen P, Naveen R, Day J, Cordeiro RA, Júnior JG, Chatterjee T, Lilleker JB, Agarwal V, Kardes S, Milchert M, Gheita T, Salim B, Velikova T, Gracia-Ramos AE, Parodis I, O'Callaghan AS, Nikiphorou E, Makol A, Tan AL, Cavagna L, Saavedra MA, Ziade N, Knitza J, Kuwana M, Nune A, Distler O, Chinoy H, Agarwal V, Aggarwal R, Gupta L. Pain in individuals with idiopathic inflammatory myopathies, other systemic autoimmune rheumatic diseases, and without rheumatic diseases: A report from the COVAD study. Int J Rheum Dis 2023; 26:727-739. [PMID: 36872076 DOI: 10.1111/1756-185x.14636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To compare pain intensity among individuals with idiopathic inflammatory myopathies (IIMs), other systemic autoimmune rheumatic diseases (AIRDs), and without rheumatic disease (wAIDs). METHODS Data were collected from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an international cross-sectional online survey, from December 2020 to August 2021. Pain experienced in the preceding week was assessed using numeral rating scale (NRS). We performed a negative binomial regression analysis to assess pain in IIMs subtypes and whether demographics, disease activity, general health status, and physical function had an impact on pain scores. RESULTS Of 6988 participants included, 15.1% had IIMs, 27.9% had other AIRDs, and 57.0% were wAIDs. The median pain NRS in patients with IIMs, other AIRDs, and wAIDs were 2.0 (interquartile range [IQR] = 1.0-5.0), 3.0 (IQR = 1.0-6.0), and 1.0 (IQR = 0-2.0), respectively (P < 0.001). Regression analysis adjusted for gender, age, and ethnicity revealed that overlap myositis and antisynthetase syndrome had the highest pain (NRS = 4.0, 95% CI = 3.5-4.5, and NRS = 3.6, 95% CI = 3.1-4.1, respectively). An additional association between pain and poor functional status was observed in all groups. Female gender was associated with higher pain scores in almost all scenarios. Increasing age was associated with higher pain NRS scores in some scenarios of disease activity, and Asian and Hispanic ethnicities had reduced pain scores in some functional status scenarios. CONCLUSION Patients with IIMs reported higher pain levels than wAIDs, but less than patients with other AIRDs. Pain is a disabling manifestation of IIMs and is associated with a poor functional status.
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Affiliation(s)
- Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Minchul Kim
- Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | | | - Rafael Giovani Missé
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rafael Alves Cordeiro
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jucier Gonçalves Júnior
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tulika Chatterjee
- Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | - James B Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - Sinan Kardes
- Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Marcin Milchert
- Department of Internal Medicine, Rheumatology Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Tsvetelina Velikova
- Department of Clinical Immunology, Medical Faculty, University Hospital "Lozenetz", Sofia University St. Kliment Ohridski, Sofia, Bulgaria
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Albert Selva O'Callaghan
- Internal Medicine Department, Vall D'hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Italy
| | - Miguel A Saavedra
- Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Johannes Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Arvind Nune
- Southport and Ormskirk NHS Trust, Southport, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hector Chinoy
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Latika Gupta
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Kim SY, Park SY, Mathai B, Daheim J, France C, Delgado B. Cultural dimensions of individualism and collectivism and risk of opioid misuse: A test of Social Cognitive Theory. J Clin Psychol 2022; 78:2341-2356. [PMID: 35881671 PMCID: PMC9796527 DOI: 10.1002/jclp.23425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite the critical role social and cultural contexts play in pain experience, limited theoretical and empirical attention has been devoted to the interplay between social, cognitive, cultural, and psychological factors in chronic pain management and the risk of opioid misuse. METHODS Using structural equation modeling, the present study tested the Social Cognitive Theory (SCT) of chronic pain management and risk of opioid misuse in the context of intraindividual cultural dimensions of individualism and collectivism among 316 ethnically diverse adults with chronic pain in the United States. RESULTS Social cognitive predictors account for a significant amount of variance in pain dysfunction and risk of opioid misuse in adults with chronic pain. Satisfaction with pain support was positively associated with both greater pain acceptance and greater pain self-efficacy. Individualism was found to be positively associated with satisfaction with pain support, pain self-efficacy, and pain acceptance but negatively associated with the risk of opioid misuse. Collectivism was positively associated with the risk of opioid misuse. CONCLUSIONS The study findings not only empirically support using SCT for adults with chronic pain, but also provide a more thorough conceptual framework that highlights the intracultural diversity and interplay among social, cognitive, and psychological factors that affect pain experience and the risk of opioid misuse among adults with chronic pain.
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Affiliation(s)
- Shin Ye Kim
- Department of Counseling PsychologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Sung Yong Park
- Department of PsychologyKeimyung UniversityDaeguSouth Korea
| | - Babetta Mathai
- Department of Clinical and Health PsychologyUniversity of Florida Health Science CenterGainesvilleFloridaUSA
| | - Jacob Daheim
- Department of Psychological SciencesTexas Tech UniversityLubbockTexasUSA
| | | | - Betsaida Delgado
- Department of Psychological SciencesTexas Tech UniversityLubbockTexasUSA
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Sutherland N, Ward-Griffin C, McWilliam C, Stajduhar K. Discourses Reproducing Gender Inequities in Hospice Palliative Home Care. Can J Nurs Res 2018; 50:189-201. [PMID: 30025468 DOI: 10.1177/0844562118788239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND As home is a site where gendered attitudes, beliefs, and practices are reproduced, it is imperative that policies and practices promote gender equity in end-of-life care at home. PURPOSE The purpose of this study was to critically analyze gender relations in the sociopolitical context of hospice palliative home care. METHODS Using a critical feminist perspective, we examined gender relations between and among clients with cancer, their family caregivers, and nurses in hospice palliative home care. Ethnographic methods of in-depth interviews (n = 25), observations of home visits (n = 9), and review of documents (n = 12) were employed to expose gender (in)equities. FINDINGS This critical analysis sheds light on institutional discourses that reproduce gender inequities: discourses of difference and denial; discourses of individuality, autonomy, and choice; and discourses of efficiency, objectivity, and rationality. Although gender was discounted, these neoliberal discourses reinforced traditional gender relations. DISCUSSION Neoliberal discourses frame health and health-care experiences as resulting primarily from individual behaviors and biomedical factors, permitting health-care providers and policy makers to overlook power relations and the sociopolitical forces that obscure gender inequities. A critical perspective is needed to consider how social structures significantly shape everyday gendered experiences in hospice palliative home care.
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Affiliation(s)
- Nisha Sutherland
- 1 School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | | | - Carol McWilliam
- 2 Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kelli Stajduhar
- 3 School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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Pathmawathi S, Beng TS, Li LM, Rosli R, Sharwend S, Kavitha RR, Christopher BCM. Satisfaction with and Perception of Pain Management among Palliative Patients with Breakthrough Pain: A Qualitative Study. Pain Manag Nurs 2016; 16:552-60. [PMID: 26256219 DOI: 10.1016/j.pmn.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/06/2014] [Accepted: 10/10/2014] [Indexed: 11/30/2022]
Abstract
Breakthrough pain is a significant contributor to much suffering by patients. The experience of intense pain may interfere with, and affect, daily life functioning and has major consequences on patients' well-being if it is not well managed. The area of breakthrough pain has not been fully understood. This study thus aimed to explore the experiences of breakthrough pain among palliative patients. A qualitative study based on a series of open-ended interviews among 21 palliative patients suffering from pain at an urban tertiary hospital in Malaysia was conducted. Five themes were generated: (i) pain viewed as an unbearable experience causing misery in the lives of patients, (ii) deterioration of body function and no hope of recovery, (iii) receiving of inadequate pain management for pain, (iv) insensitivity of healthcare providers toward patients' pain experience, and (v) pain coping experiences of patients. The findings revealed that nonpharmacologic approaches such as psychosocial support should be introduced to the patients. Proper guidance and information should be given to healthcare providers to improve the quality of patient care. Healthcare providers should adopt a sensitive approach in caring for patients' needs. The aim is to meet the needs of the patients who want to be pain free or to attain adequate relief of their pain for breakthrough pain.
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Affiliation(s)
- Subramanian Pathmawathi
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee Mei Li
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roshaslina Rosli
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Supermanian Sharwend
- Faculty of Medicine and Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Rasaiah R Kavitha
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Santos Salas A, Fuentes Contreras J, Armijo-Olivo S, Saltaji H, Watanabe S, Chambers T, Walter L, Cummings GG. Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis. SUPPORTIVE CARE IN CANCER : OFFICIAL JOURNAL OF THE MULTINATIONAL ASSOCIATION OF SUPPORTIVE CARE IN CANCER 2015. [PMID: 26556211 DOI: 10.1007/s00520‐015‐2998‐9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Global advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances. RESEARCH PURPOSE A systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender. METHODS Randomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled. RESULTS The search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts. CONCLUSION Results show the need to examine supportive care interventions particularly in populations with social disparities.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Jorge Fuentes Contreras
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica del Maule, Avda. San Miguel 3605, Talca, Chile
| | - Susan Armijo-Olivo
- Research Centre Faculty of Rehabilitation Medicine, 3-62 Corbett Hall, University of Alberta, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Humam Saltaji
- School of Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sharon Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Room 2001, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta Libraries, Edmonton, AB, T6G 2R7, Canada
| | - Lori Walter
- UBC Okanagan Library, The University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Greta G Cummings
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Santos Salas A, Fuentes Contreras J, Armijo-Olivo S, Saltaji H, Watanabe S, Chambers T, Walter L, Cummings GG. Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis. Support Care Cancer 2015; 24:985-1000. [PMID: 26556211 DOI: 10.1007/s00520-015-2998-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/26/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Global advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances. RESEARCH PURPOSE A systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender. METHODS Randomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled. RESULTS The search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts. CONCLUSION Results show the need to examine supportive care interventions particularly in populations with social disparities.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Jorge Fuentes Contreras
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica del Maule, Avda. San Miguel 3605, Talca, Chile
| | - Susan Armijo-Olivo
- Research Centre Faculty of Rehabilitation Medicine, 3-62 Corbett Hall, University of Alberta, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Humam Saltaji
- School of Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sharon Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Room 2001, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta Libraries, Edmonton, AB, T6G 2R7, Canada
| | - Lori Walter
- UBC Okanagan Library, The University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Greta G Cummings
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Luckett T, Davidson PM, Green A, Boyle F, Stubbs J, Lovell M. Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care. J Pain Symptom Manage 2013; 46:229-53. [PMID: 23159681 DOI: 10.1016/j.jpainsymman.2012.07.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/23/2012] [Accepted: 07/28/2012] [Indexed: 11/26/2022]
Abstract
CONTEXT Cancer pain is a common, burdensome problem, which is not well managed despite evidence-based guidelines. OBJECTIVES To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care. METHODS We undertook a systematic review and synthesis of qualitative studies. Medline, PsycINFO, Embase, AMED, CINAHL, and Sociological Abstracts were searched from May 20 to 26, 2011. To be included, the articles had to be published in a peer-reviewed journal since 2000; written in English; and report original qualitative studies on the perspectives of patients, their significant others, or health care providers. Article quality was rated using the checklist of Kitto et al. Thematic synthesis followed a three-stage approach using Evidence for Policy and Practice Information and Co-ordinating Centre-Reviewer 4 software: 1) free line-by-line coding of "Results," 2) organization into "descriptive" themes, and 3) development of "analytical" themes informative to our objective. At Stage 3, a conceptual framework was selected from the peer-reviewed literature according to prima facie "fit" for descriptive themes. RESULTS Of 659 articles screened, 70 met the criteria, reporting 65 studies with 48 patient, 19 caregiver, and 21 health care provider samples. Authors rarely reported reflexivity or negative cases. Mead and Bower's model of patient-centered care accommodated 85% of the descriptive themes; 12% more related to the caregiver and service/system factors. Three themes could not be accommodated. CONCLUSION Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials.
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Affiliation(s)
- Tim Luckett
- Improving Palliative Care through Clinical Trials, New South Wales Palliative Care Clinical Trials Collaborative, Sydney, NSW 2007, Australia.
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Haozous EA, Knobf MT. "All my tears were gone": suffering and cancer pain in Southwest American Indians. J Pain Symptom Manage 2013; 45:1050-60. [PMID: 22940564 PMCID: PMC3514593 DOI: 10.1016/j.jpainsymman.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/07/2012] [Accepted: 06/25/2012] [Indexed: 11/18/2022]
Abstract
CONTEXT Although minority patients with cancer are more likely to be undermedicated for cancer pain than non-Hispanic whites, little is known about the experience of cancer pain in American Indians (AIs). OBJECTIVES To describe the experience of cancer and cancer pain in a sample of southwestern AIs. METHODS Ethnographic interviews were conducted with 13 patients and 11 health care providers, caregivers, and community members; two questionnaires were used to collect demographic and pain data. RESULTS Barriers to pain control among AIs included difficulties describing pain, a belief that cancer pain is inevitable and untreatable, and an aversion to taking opioid pain medication. Prescriber inexperience also was cited as a barrier to pain management. AIs described a strong desire to protect their privacy regarding their illness, and many felt that expressing pain was a sign of weakness. The inability to participate in spiritual and cultural activities caused AIs distress, and some discontinued treatment or missed chemotherapy appointments to engage in these activities. CONCLUSION Results revealed new knowledge about the cancer pain experience in AIs. The observation of the close relationship between treatment compliance and the patient's ability to participate in ceremonial and spiritual activities provides new insight into the problem of incomplete cancer treatment in this population. The finding that AI patients have a multidimensional conceptualization of pain will assist clinicians with obtaining more detailed and informative pain assessments.
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Affiliation(s)
- Emily Ann Haozous
- University of New Mexico College of Nursing, Albuquerque, New Mexico, USA.
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Abstract
The purpose of this study was to develop a decision support system using fuzzy logic that would support nurses' decisions about cancer pain management, especially for ethnic minority cancer patients. The study had two phases: (1) data collection and (2) development of the decision support computer program. In the data collection phase, an Internet survey of 428 cancer patients and four ethnic-specific online forums (about 30 participants per forum) were conducted to gather data on the cancer pain experience of the four major ethnic groups in the United States. The development phase included two components: (1) development of three modules, including a knowledge base module, a decision module, and a self-adaptation module; and (2) a 3-month evaluation of the decision support computer program by oncology nurses and subsequent incorporation of their feedback into the program. The Internet survey and online forum data were processed into fuzzy and crisp data sets, and ethnic-specific algorithms for the decision module were developed. Using the self-adaptation module, the decision support computer program was further refined as additional data were processed. Then, the decision support computer program was further developed by adding additional components suggested by the oncology nurses.
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10
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Hallac S, Oz F. Existential Anxiety in Diagnostic Process of Genital Cancer. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2011. [DOI: 10.5455/cap.20110326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Im EO, Lee SH, Liu Y, Lim HJ, Guevara E, Chee W. A national online forum on ethnic differences in cancer pain experience. Nurs Res 2009; 58:86-94. [PMID: 19289929 PMCID: PMC2668932 DOI: 10.1097/nnr.0b013e31818fcea4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cultural values and beliefs related to cancer and pain have been used to explain ethnic differences in cancer pain experience. Yet, very little is known about similarities and differences in cancer pain experience among different ethnic groups. OBJECTIVE The objective of this study was to explore similarities and differences in cancer pain experience among four major ethnic groups in the United States. METHODS A feminist approach by Hall and Stevens was used. This was a cross-sectional qualitative study among 22 White, 15 Hispanic, 11 African American, and 27 Asian patients with cancer recruited through both Internet and community settings. Four ethnic-specific online forums were conducted for 6 months. Nine topics related to cancer pain experience were used to guide the online forums. The collected data were analyzed using thematic analysis involving line-by-line coding, categorization, and thematic extraction. RESULTS All participants across ethnic groups reported "communication breakdowns" with their healthcare providers and experienced "changes in perspectives." All of them reported that their cancer pain experience was "gendered experience." White patients focused on how to control their pain and treatment selection process, whereas ethnic minority patients tried to control pain by minimizing and normalizing it. White patients sought out diverse strategies of pain management; ethnic minority patients tried to maintain normal lives and use natural modalities for pain management. Finally, the cancer pain experience of White patients was highly individualistic and independent, whereas that of ethnic minority patients was family oriented. DISCUSSION These findings suggest that nurses need to use culturally competent approaches to cancer pain management for different ethnic groups. Also, the findings suggest further in-depth cultural studies on the pain experience of multiethnic groups of patients with cancer.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, University of Texas at Austin, 1700 Red River, Austin, TX 78701, USA.
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12
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Abstract
Studies have indicated the need for theories that explain and target ethnic-specific cancer pain experiences, including those of Asian Americans. In this article, I present a situation-specific theory that explains the unique cancer pain experience of Asian Americans. Unlike other existing theories, this situation-specific theory was developed on the basis of evidence, including a systematic literature review and research findings, making it comprehensive and highly applicable to research and practice with Asian American patients with cancer. Thus, this theory would strengthen the interconnections among theory, evidence, and practice in pain management for Asian American cancer patients.
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Abstract
The purpose of this study was to explore demographic characteristics of a specific online population, midlife women recruited through Internet communities or groups, and to provide future direction for Internet research among midlife women. Using a feminist perspective, the study focused on ethnic variations in the characteristics of the midlife women. A total of 192 midlife women were recruited through Internet communities. The Internet survey included questions on sociodemographic characteristics and health/illness status. The data were analyzed using descriptive and inferential statistics. The findings indicated that midlife women recruited through Internet communities tended to be white, young, married, and affluent. The findings also indicated significant ethnic differences in sociodemographic characteristics. The findings suggest that researchers need to consider that midlife women recruited from Internet communities tend to be a specific group of midlife women.
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Abstract
Although very little is known about African American cancer patients' pain experience, a few studies have indicated that their cancer pain experience is unique and somewhat different from that of other ethnic groups. The purpose of the study reported in this article was to explore African American cancer patients' pain experience using an online forum. This study was a qualitative online forum designed from a feminist perspective and conducted among 11 African American cancer patients who were recruited through both Internet and real settings. Nine online forum topics were used to administer the 6-month online forum, and the data were analyzed using thematic analysis. Four themes emerged through the data analysis process. First, participants viewed cancer as a challenge in life that they should fight against. Second, cancer pain was differentiated from ordinary pain because cancer was stigmatized in their culture. Third, participants viewed that African Americans, especially women, were culturally raised to be strong, and this African American cultural heritage inhibited cancer patients from expressing pain and seeking help for pain management. Finally, the findings indicated certain changes in perspectives among African American cancer patients during the disease process, which might make them tolerate pain through praying to God and reading the Bible. Based on the findings, we suggest further studies among diverse groups of African American cancer patients, with a focus on cultural attitudes toward cancer pain and influences of family on cancer pain experience.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, The University of Texas at Austin, Texas 78701, USA.
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Im EO, Chee W, Guevara E, Liu Y, Lim HJ, Tsai HM, Clark M, Bender M, Suk Kim K, Hee Kim Y, Shin H. Gender and ethnic differences in cancer pain experience: a multiethnic survey in the United States. Nurs Res 2007; 56:296-306. [PMID: 17846550 PMCID: PMC2728600 DOI: 10.1097/01.nnr.0000289502.45284.b5] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inconsistent findings on ethnic differences in cancer pain experience suggest the need for further studies on this topic for adequate cancer pain management. OBJECTIVES To determine ethnic differences in cancer pain experience of four ethnic groups in the United States. METHODS A feminist perspective was used as the theoretical basis. This was a survey of a multiethnic sample of 480 cancer patients asking questions on sociodemographic characteristics and health or illness status, 3 unidimensional cancer pain scales, 2 multidimensional cancer pain scales, the Memorial Symptom Assessment Scale, and the Functional Assessment of Cancer Therapy Scale. The data were analyzed using descriptive and inferential statistics including ANOVA and hierarchical multiple regression analyses. RESULTS The results indicated certain ethnic differences in types of pain and symptoms that patients experienced. Also, the results demonstrated significant ethnic differences in cancer pain and functional status. DISCUSSION The findings suggest further in-depth qualitative exploration on cultural values and beliefs related to cancer pain in each ethnic group and national studies with a larger number of ethnic minorities on this topic.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, University of Texas at Austin, USA.
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Abstract
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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Affiliation(s)
- Eun-Ok Im
- School of Nursing, University of Texas, Austin, USA.
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