Guadalupe R. Palos

Minority cancer patients and their providers : Pain management attitudes and practice

The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African‐American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them.

Cancer pain management among underserved minority outpatients: Perceived needs and barriers to optimal control

Minority patients with cancer are at risk for undertreatment of cancer‐related pain. Most studies of patient‐related barriers to pain control have surveyed primarily non‐Hispanic Caucasian patients. The purpose of the current study was to explore barriers to optimal pain management among African‐American and Hispanic patients with cancer through the use of structured patient interviews. Structured interviews allowed the authors to probe for previously unidentified barriers to pain management in these populations.

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

PURPOSE Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. PATIENTS AND METHODS Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. RESULTS Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. CONCLUSION Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.

Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer.

The growing diversity of the population of the United States and the high burden of cancer‐related symptoms reflect the need for caregiver research within underserved groups. In this longitudinal study, the authors assessed changes in symptom severity in caregivers and underserved minority patients diagnosed with advanced solid tumors who were being treated at public hospitals.

Cultural Influences in the Patterns of Long-Term Care Use Among Mexican American Family Caregivers

This study sought to explore cultural attitudes toward caregiving and long-term care and their influence on patterns of long-term care use among Mexican American family caregivers of relatives aged 50 and older. Using a cross-sectional design, the researchers used mixed methods and conducted interviews with 66 Mexican American family caregivers in San Diego, California. They applied the Andersen behavioral model of health service utilization to examine familism, gender roles, acculturation, religiosity, and knowledge and perceptions of long-term care as factors in usage. Caregivers with greater long-term care use displayed lower levels of familism, were knowledgeable about services, had a care recipient with health insurance, shared caregiving responsibilities, and were less acculturated. Medicaid coverage for low-income care recipients was associated with higher long-term care use. Although familism may deter service use, caregivers empowered with resources and knowledge or Medicaid coverage are inclined to use long-term care services.

Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI-GI).

The M. D. Anderson Symptom Inventory (MDASI) was developed as a brief yet comprehensive tool to assess patient‐reported symptom severity and interference in patients with cancer. The authors report the development of an MDASI module for use in patients with gastrointestinal (GI) cancer (the MDASI‐GI).

Levels of Symptom Burden During Chemotherapy for Advanced Lung Cancer: Differences Between Public Hospitals and a Tertiary Cancer Center

PURPOSE We compared risk factors for high disease- and treatment-related symptom burden over 15 weeks of therapy in medically underserved patients with advanced non-small-cell lung cancer and in patients treated at a tertiary cancer center. PATIENTS AND METHODS We monitored symptom severity weekly during chemotherapy. Patients were recruited from a tertiary cancer center (n=101) and three public hospitals treating the medically underserved (n=80). We used a composite symptom-severity score and group-based trajectory analysis to form two groups: one with consistently more severe symptoms and another with less severe symptoms. We examined predictors of group membership. RESULTS Seventy percent of the sample (n=126) reported low symptom-severity levels that decreased during therapy; 30% (n=55) had consistently severe symptoms throughout the study. In multivariate analysis, patients with good performance status being treated in public hospitals were significantly more likely than patients treated at the tertiary cancer center to be in the high-symptom group (odds ratio, 5.6; 95% CI, 2.1 to 14.6; P = .001) and to report significantly higher symptom interference (P = .001). Other univariate predictors of high-symptom group membership included variables associated with being medically underserved (eg, having less education, being single, and being nonwhite). No group differences by ethnicity were observed in the public hospitals. Medically underserved patients were less likely to receive adequate pain management. CONCLUSION Patients with advanced lung cancer and good performance status treated at public hospitals were more likely than those treated at a tertiary cancer center to experience substantial symptoms during chemotherapy.

Bereaved Parents' Perspectives on Pediatric Palliative Care

This studys goal was to describe and begin to understand the experience of bereaved parents whose deceased child had received pediatric oncology services at a tertiary comprehensive cancer center. Focus groups were conducted with parents whose children were age 10 years and older at the time of death. Potential participants were contacted by mail and telephone. Sessions were audiotaped and transcribed verbatim. The ATLAS.ti qualitative software program was used to identify and analyze dominant themes. Fourteen parents identified four major themes: standards of care, emotional care, communication, and social support. Bereaved parents discussed the challenges associated with institutional procedures and interpersonal aspects of care in anticipation of and following their childs death. The results of these personal narratives may be used to guide care plans and deliver pediatric palliative and end-of-life interventions.

Patients, family caregivers, and patient navigators: a partnership approach.

Navigation services may be strengthened by establishing a partnership between the patient, family/caregiver, and the navigator. Involvement of a patients familial or social network in the navigation process would allow patient navigators to spend more time and resources with the subset of patients who do not have support from family and friends. The Partnership Approach evolves from combining the strength of a patients existing social support and network with the delivery of navigation services.

Cultural heritage: Cancer screening and early detection

An individual is influenced by a number of diverse cultural factors, and the interaction of cultural beliefs can create barriers to compliance with recommended prevention, early detection, and screening activities. In order to develop culturally and linguistically appropriate cancer screening and early detection programs, clinicians need to have some background knowledge of culturally diverse populations. In addition, multilevel theoretical models should be used to plan cancer control programs that address the diversity from confluent cultures.