Developing, testing, and refining a culturally and linguistically appropriate intervention for Mexican Americans with cancer pain will contribute to the elimination of health disparities in this population. This goal is congruent with the overall NIH mission to support science that reduces the burden of illness and disability. Funding will stimulate the educational and economic status of students by providing five job positions (ARRA purpose) and expose Hispanic nursing students to meritorious research. Last, the project will strengthen the research capacity of the School of Nursing in a Minority Serving Institution (R-15 purpose) by increasing the pool of future nurse scientists and establishing the infrastructure for future research in a minority population plagued with disparities. Cancer pain is of significant concern on social, economic and individual levels for the estimated 11 million Americans who have a cancer diagnosis (American Cancer Society, 2008). In a recent systematic review of the world-wide prevalence of pain in patients with cancer, those with metastatic, advanced or terminal disease reported pain prevalence rates of 64%, with more than one-third grading their pain as moderate or severe (vanden Beuken-van Everdingen et al., 2007). Individuals from underserved populations are more likely than the overall United States population to suffer from inadequate cancer pain management (Cintron &Morrison, 2006;Green et al., 2003;McNeill, Reynolds, &Ney, 2007;National Cancer Institute, 2005). Such disparities in pain management increase the likelihood of minorities suffering from the costly consequences of uncontrolled pain such as depression, sleep disorders, lost work productivity, and impaired relationships with family and friends (American Pain Foundation, 2009;Monsivais &Robinson, 2008). Patient beliefs, attitudes, and communication styles are tightly interwoven, culturally bound, and can be significant barriers to effective pain management (Ward et al., 1993;Gunnarsdottir, Donovan, Serlin, Voge, &Ward, 2002). In turn, inadequate assessment by providers of patients'beliefs and attitudes, coupled with poor provider communication, contribute to disparities in cancer pain management for vulnerable populations (Green et al., 2003;Cintron &Morrison, 2006;McNeill et al., 2007). Cancer pain communication problems are of special concern for those of Hispanic origin, because cancers with higher rates among Hispanics, such as stomach, liver, biliary tract, and uterine cervix, are generally associated with extreme pain (American Cancer Society, 2009). In areas along the US-Mexico border in far west Texas where Hispanics of Mexican American origin exceed 78% of the population, the need for culturally and linguistically effective interventions for improved cancer pain management is critical. Emerging evidence suggests an individualized educational intervention called RidCancerPain (Ward et al, 2008;Ward et al., 2009) is effective in overcoming barriers to pain management and can promote decreased pain, improved mood, and increased quality of life. Further testing of this promising intervention is needed in minority populations. Therefore the purpose of this study is to develop, test, and refine a cancer pain intervention to meet the cultural and linguistic needs of Hispanics along the US-Mexico border. We will do this by translating the RidCancerPain intervention into Spanish and pilot testing the intervention for acceptability and feasibility in the target population. This process will include the translation of other research materials necessary for pilot-testing the intervention, i.e. Barriers Questionnaire II (BQ II), Satisfaction Survey, and a single item eligibility question.
The specific aims of this project are to: 1. Translate the RidCancerPain intervention guide, Barriers Questionnaire II (BQ II), Satisfaction Survey, and eligibility question into Spanish by using teams of undergraduate students under the supervision of the co-investigator to conduct text analysis and extensive research in constructive corpus terminology, translate, and field test the intervention guide and other materials into Spanish for Spanish speakers living along the US-Mexico border (Hatim, 2001;House, 1981, 1997;Toury, 1995) 2. Test the acceptability of the RidCancerPain intervention in a Hispanic Population along the US-Mexico Border by conducting a pretest-posttest single group trial and measuring acceptability of the intervention with the Satisfaction Survey 3. Assess the feasibility of conducting a trial of the RidCancerPain intervention in a Hispanic Population with cancer-related pain along the US-Mexico Border including obtaining initial estimates of the effect sizes by conducting a pretest-posttest single group trial. This project will set the stage for submitting an application to conduct a large, well-powered randomized controlled trial to test the efficacy of the RidCancerPain intervention. The future study will test the hypothesis that RidCancerPain is more efficacious than standard care with respect to decreasing attitudinal barriers and improving cancer pain management for a Hispanic population along the US-Mexico border.
Cancer pain is of significant concern on social, economic, and individual levels for the estimated 11 million Americans with a cancer diagnosis. The RidCancerPain intervention will enhance effective pain management strategies for Hispanics along the US-Mexico border, a goal congruent with the overall NIH mission to support science that reduces the burden of illness and disability.
| Campbell, Lisa C; Robinson, Kristynia; Meghani, Salimah H et al. (2012) Challenges and opportunities in pain management disparities research: implications for clinical practice, advocacy, and policy. J Pain 13:611-9 |
