Juarez G, Ferrell B, Borneman T
City of Hope National Medical Center, Duarte, CA, USA.
Cancer Pract. 1998 Sep-Oct;6(5):262-9. doi: 10.1046/j.1523-5394.1998.00020.x.
The purpose of this pilot study was to describe the influence of culture on cancer pain management in Hispanic (Mexican and Central American) patients.
This qualitative study is guided by the conceptual framework of the Pain and Quality of Life model and the Biocultural Model of Pain. It was developed as a companion study to a National Cancer Institute (NCI)-funded project to disseminate a pain education program for adult patients with cancer and their family care givers in community home-care agencies. After completing the NCI study, Hispanic subjects were invited to participate in the qualitative companion study. A total of 17 subjects, the majority of whom were women, were interviewed. The Hispanic Pain Experience Questionnaire (HPEQ) was used to elicit answers to open-ended questions regarding the perception and management of cancer pain.
Themes that emerged from the questionnaire were Influence of Culture, Expressions of Pain, Managing Pain/Medications, and Use of Nondrug Interventions. Responses suggest that culture, family beliefs, and religion contribute significantly to management and expression of pain by the patient and care giver. In addition, this group showed that pain may be approached with stoicism; therefore, lack of verbal or behavioral expression of pain does not indicate a lack of pain itself. These patients also demonstrated a reliance on folk beliefs and nondrug interventions. The most common reason cited for noncompliance with pharmacologic treatment was an inability to understand instructions.
When providing care to Hispanic patients, it is imperative to be nonjudgmental, sensitive, and respectful. To improve compliance, the multidisciplinary cancer team should 1) incorporate the patients' folk healthcare practices and beliefs into the plan of care when possible; 2) involve family members and friends in the patient's care, identifying one key family contact; and 3) ensure that instructions for medications are available in Spanish and understood by the patient and care giver. When patients' overall beliefs and values are respected, compliance with pharmacological and other interventions may increase accordingly.
本初步研究的目的是描述文化对西班牙裔（墨西哥和中美洲）患者癌症疼痛管理的影响。
这项定性研究以疼痛与生活质量模型和生物文化疼痛模型的概念框架为指导。它是作为一项由美国国立癌症研究所（NCI）资助的项目的配套研究而开展的，该项目旨在为社区家庭护理机构中成年癌症患者及其家庭护理人员推广一项疼痛教育计划。在完成NCI研究后，邀请西班牙裔受试者参与定性配套研究。共采访了17名受试者，其中大多数为女性。使用西班牙裔疼痛体验问卷（HPEQ）来获取有关癌症疼痛感知和管理的开放式问题的答案。
问卷中出现的主题包括文化的影响、疼痛的表达、疼痛管理/药物治疗以及非药物干预的使用。回答表明，文化、家庭信仰和宗教对患者和护理人员的疼痛管理和表达有显著影响。此外，该群体表明疼痛可能以坚忍的态度对待；因此，缺乏疼痛的言语或行为表达并不表明本身没有疼痛。这些患者还表现出对民间信仰和非药物干预的依赖。不遵守药物治疗最常见的原因是无法理解说明。
在为西班牙裔患者提供护理时，必须保持无偏见、敏感和尊重。为了提高依从性，多学科癌症团队应：1）尽可能将患者的民间医疗实践和信仰纳入护理计划；2）让家庭成员和朋友参与患者护理，确定一名关键的家庭联系人；3）确保有西班牙语的药物说明，且患者和护理人员能够理解。当患者总体的信仰和价值观得到尊重时，对药物和其他干预措施的依从性可能会相应提高。
