Interprofessional Webinar Series

Transcription

1 Interprofessional Webinar Series

2 Pain Assessment and Cultural Diversity Lara Dhingra, PhD Director, Health Disparities and Outcomes Research MJHS Institute for Innovation in Palliative Care

3 Disclosure Lara Dhingra, PhD, has no financial arrangements or affiliations with any commercial entities whose products, research, or services may be discussed in these materials. Any discussion of investigational or unlabeled uses of a product will be identified. Russell K. Portenoy, MD, Planner, has indicated a relationship with the following: Pfizer Inc. No other Planning Committee Member has any disclosures.

4 Objectives 1. Describe the general elements of culturally effective care 2. Discuss barriers to culturally competent pain assessment 3. Review clinical strategies for culturally relevant pain assessment and management in diverse populations with advanced medical illness

5 Culturally Effective Care: Conceptual Model Attitude Respect Knowledge Skills Cultural Sensitivity Cultural Competence Generic Specific Culturally Effective Care Patient Outcomes Adapted from Kemp, Semin Oncol Nurs, 2005.

6 Culturally Effective Care: Elements Cultural Sensitivity Awareness of how culture shapes patients values, beliefs, and world views To understand potential differences and respect them Cultural Competence Knowledge and skills required to obtain positive outcomes in cross-cultural encounters Crawley et al., Ann Intern Med, 2002; Tervalon, J Health Care Poor Underserved, 1998.

7 Benefits of Culturally Effective Care Provision of culturally effective care is consistent with patient-centered care Understanding of culture-specific values and beliefs may promote more effective pain management Knowledge and sensitivity can prevent cross-cultural conflicts, patient mistrust, and treatment nonadherence

8 Pain Care: Racial/Ethnic Disparities Minorities have significantly poorer pain outcomes and greater disparities in care Minority patients are more likely to have their pain underestimated by providers and receive inadequate treatment Both pain severity and disability are greater among African Americans and Hispanics compared to non-hispanic whites Goodin et al., Health Psychol, 2013; Rahim-Williams et al., Pain Med, 2012; Anderson et al., J Pain, 2009.

9 Barriers to Multicultural Pain Assessment Patient and family Provider System Johnson, J Palliat Med, 2013.

10 Patient and Family Factors Language and communication issues Includes both linguistic and nonverbal differences Level of numeric literacy/familiarity with pain scales Acculturation May influence the appraisal of pain, pain expression, and desire for treatment Stoicism Can affect the willingness to express pain publicly Anderson et al., J Pain, 2009; Davidhizar et al., Int Nurs Rev, 2004; Narayan, Am J Nurs, 2010; Anderson et al., Cancer, 2002; Im, Cancer Nurs

11 Patient and Family Factors (Cont'd) Beliefs about Western medicine Potential for historical mistrust of the healthcare system May involve preferences for complementary and alternative approaches Shame/stigma of illness In certain cultures, some diseases are taboo Family influences Caregivers may play a key role in pain care decisions and treatment Anderson et al., J Pain, 2009; Davidhizar et al., Int Nurs Rev, 2004.

12 Patient and Family Factors (Cont d) Religious/spiritual beliefs Disease-specific fatalism is the belief that pain is an inevitable part of the disease and attempts to control it are futile Religious fatalism is the belief that pain should be endured for spiritual purposes Davidhizar et al., Int Nurs Rev, 2004; Juarex, Quality of Life, 1997; Portenoy et al., 2004; Anderson et al., Cancer

13 Provider Factors Attitudes, beliefs, and knowledge of pain Knowledge of patients cultural practices and beliefs Congruity with patients backgrounds Stereotyped thinking/bias Ethnocentrism Insight into own values/beliefs Van Ryn et al., Soc Sci Med, 2000; Anderson et al., Cancer, 2000; Crawley, J Palliat Med, 2005; Crawley et al. Ann Intern Med. 2002; Mazanec et al., Home Healthcare Nurse, 2004.

14 System Factors Facilities may apply a one-size-fits-all approach to care Time constraints Patient to provider ratio Limited access to multilanguage measures Mazanec et al., Home Healthcare Nurse, 2004; Elcigil et al., J Pediatr Hematol Oncol, 2011; Anderson et al., J Pain, 2009; Pillay et al., Procedia - Social and Behavioral Sciences, 2014.

15 Clinical Strategies: Multilanguage Pain Assessment Tools Wong-Baker FACES Scale Brief Pain Inventory Short Form Condensed Memorial Symptom Assessment Scale Potential to improve pain assessment and pain communication between patients and providers Virojphan et al., Clin J Oncol Nurs, 2008.

16 Wong-Baker FACES Scale Available in 50 languages Developed for children; validated in multiple adult populations Patient chooses the face best representing current pain severity Wong-Baker FACES Foundation.

17 Brief Pain Inventory Short Form Available in 24 languages 15-item self-report measure that evaluates pain-related: Severity; other characteristics Impact on daily function Treatments Pain is rated in the past 24 hours or past week Response range from: 0 (No pain/does not interfere) to 10 (Pain as bad as you can imagine/completely interferes) Daut et al., Pain, 1983.

18 Condensed Memorial Symptom Assessment Scale Available in English and Chinese 14-item self-report measure evaluating: Physical and psychological symptoms in the past week Evaluates symptom: Presence/absence Distress on a 5-point scale, ranging from: 0 (Not at all) to 4 (Very much) Chang et al., Cancer Invest., 2004; Portenoy et al., Eur J Pain, 1994.

19 Clinical Strategies: Culturally Relevant Pain Assessment Identify the decision-maker and family spokesperson Assess patient and families expectations for communication Assess the patient's and family s perceptions of the pain, and the acculturation level of the patient and each caregiver Provide a safe space for bringing up uncomfortable topics Validate pain control as a goal of medical/psychosocial care Continued

20 Clinical Strategies: Culturally Relevant Pain Assessment Strive for clear comprehension by patients and families about care, and consistent explanations by providers Acknowledge potential for side effects (assure flexibility) Address fears of an overly aggressive medical system Express respect for the patient, family, and cultural traditions when communicating Ensure open-ended communication to balance pain care needs with culturally specific issues (e.g., concerns about medication, maintenance of respect and hope, closure)

21 Summary Minorities have significantly poorer pain outcomes and greater disparities in care Culturally effective care comprises both provider competence and sensitivity Patient and family, provider, and system-related barriers may impede pain communication, assessment, and management Cultural assessment includes an understanding of patients values and beliefs, perceptions about pain, and treatment preferences Strong communication skills are key

22 Pain Assessment and Cultural Diversity Q/A