Congress Abstracts 2004

23

UNDERSTANDING THE CANCER PAIN EXPERIENCE IN THE PLAINS NATIVE AMERICAN POPULATION. Emily Haozous, RN, MSN, The Connecticut Hospice, Branford, CT.

It has been well documented that cancer pain is under treated in minority populations. Nurses are frequently the primary individuals responsible for pain assessment. Understanding the cultural context in which a population operates will assist nurses in identifying and managing cancer pain in that group of people.

This descriptive study of 10 subjects with cancer from the Crow, Northern Cheyenne, and Sioux tribes explored how they talked about their pain, what they expected to be done for their pain, and methods of coping they used to control their cancer symptoms. This knowledge will assist nurses in developing better interventions to identify and manage cancer pain in Native American patients from the northern plains region of the United States.

This study was conducted under the theoretical base of Madeliene Leininger’s Theory of Culture Care Diversity and Universality. According to this theory, culturally congruent care is facilitated by the nurse’s understanding of the cultural context of an experience. Examining the meaning, vocabulary, and traditional remedies for cancer pain, and understanding their interplay as described in Leininger’s Sunrise Model for Culture Congruent Care allows nursing care, decisions, and actions to be positively influenced in a manner that preserves the cultural integrity of the patient while delivering effective care.

The purpose of this study is to explore Plains Indian experiences of cancer pain in order to develop culturally appropriate means of measuring cancer pain within the Plains Indian population. The study will also investigate the attitudes this population has about pain control and their expectations for pharmacologic intervention with cancer pain. The sample is a convenience sample of a group of self-selected adult Plains Native American individuals who were either currently experiencing cancer pain or had experienced cancer pain in the past. The sample was recruited through referral from their oncology care providers. Each study participant was asked to fill out a simple demographic questionnaire for the purpose of obtaining information on gender, age, cancer diagnosis, tribal affiliation, level of education, analgesic medications being used, and economic status. Every subject was asked to complete the Brief Pain Inventory (BPI). Interviews were semi-structured and had a total of nine questions concerning cancer pain, description of pain, and expectations regarding pain.

Analysis of the data was quantitative and qualitative. The BPI data were analyzed using basic descriptive statistical analysis. Field notes were taken during the interviews. The researcher transcribed the audio recordings made of the interviews. The transcribed interviews were systematically analyzed one by one. In addition, M. Tish Knobf, PhD, independently reviewed three interviews as well as the coded and analyzed content of all the interviews. Repeated themes, ideas, or phenomenon were labeled and coded according to frequency. Additionally, transcribed interviews were arranged using a “cut and paste” method in which comments were organized and arranged in tables according to thematic material.

On the BPI, subjects reported mild to moderate pain on a daily basis. The results of the BPI analysis also showed that the sample did experience mild to moderate interference with their quality of life as a direct result of their pain. When interviewed, the subjects discussed the way they described their pain, what their pain meant, and other bothersome symptoms. They also described the ways in which they experienced social isolation as a consequence of their cancer pain. The subjects selected certain people with whom they disclosed their pain. They relied on prescription and non-prescription medication for pain relief.

Implications for practice include the need for discussion of quality-of-life indicators when conducting a thorough pain assessment, once a trusting relationship is established. Suggestions for future research include further investigation into the meaning and experience of social isolation as a consequence of cancer pain.