Background: Undertreatment of pain in hospitalized patients contributes to increased length of stay and adverse clinical outcomes. Hispanics are at high risk for inadequate pain management. Patient factors, inadequate knowledge and health beliefs, are confounded by failures of the health care system, notably, lack of Spanish language tools and lack of cultural understanding among health care providers. Objective: The purpose of this study was to examine the pain experience among Latinos who have had a recent pain experience and use that information to develop a Spanish language, culturally relevant instrument modeled on the existing American Pain Society Patient Outcome Questionairre (APS-POQ). Design: The first phase of the two phase project began with qualitative interviews to gain a perspective on acute pain from the point of view of Latinos recovering from a surgical experience, using the data to craft a new instrument. The second phase tested the psychometric properties of the new instrument, as well as provided additional data to understand the pain experience of Latino patients. Population/Sample: In the first phase, 35 patients were interviewed by trained interviewers either in person or by telephone; these participants were self identified Latinos, ranging in age from 18 to 77+ years, who had had a recent surgery. Using the same inclusion criteria, 150 Latinos participated in Phase II for psychometric testing of the new instrument. Methods: A combination of focus groups and individual interviews conducted in Spanish and English yielded qualitative data. Descriptive qualitative analysis identified patterns and themes describing the acute pain experience. Items were used to develop the new survey instrument assessing the pain experience from a Latino perspective. The survey instrument and a demographic tool, available in both Spanish and English, were subsequently tested using trained bilingual interviewers. Information was obtained from the medical record regarding the analgesic regimen ordered and administered within the last 24 hours. Pain Management Index (PMI) scores were computed from worst pain ratings and categories of analgesics administered. Findings. Descriptive qualitative analysis identified themes related to beliefs about pain, pain’s interference with daily activities and relationships, management strategies, and opinions about health professionals’ care. The second phase of the study used the qualitative analysis to draft an instrument derived from the APS-POQ. The pain intensity, pain interference, satisfaction and beliefs subscales were modified with new wording reflecting specific cultural perspectives; a subscale about pain’s interference with emotional well-being was added, as was an expectations subscale, including the pain relief goal. Patient satisfaction items were revised from items suggested in the interviews, e.g., being treated with respect, level of personal concern, family involvement, and instruction about pain management. The barriers/beliefs portion of the APS-POQ was revised to reflect culturally specific beliefs that pose barriers to pain management, e.g., pain’s influence on feelings of control, use of non-drug methods for relief, and partnerships for pain management. Finally, a subscale regarding patient-initiated management strategies was compiled from reported strategies, e.g., prayer for self, tensing/relaxing, acceptance, drinking teas, and others which are rated as to use and effectiveness. The new instrument, the Houston Pain Management Outcome Instrument, was subjected to content validity to assess the relevance and clarity of the items (Lynn, 1986). A bilingual Advisory Board as well as bilingual Latinos with recent surgical pain experience tested the new tool in order to establish equivalence of Spanish and English forms. The presentation will focus on description of the pain experience and satisfaction issues for 150 Latino participants. Regression analysis delineated the influence of factors predicting the outcomes, which included pain intensity, patient satisfaction and PMI scores from the independent variables. Conclusions. The Hispanic’s acute pain experience is influenced by physical, emotional and social factors. Satisfaction with management of pain is influenced by relationships with care providers, family support and the information Hispanic patients receive about their management. A culturally sensitive instrument, in the patient’s preferred language, can provide a means to obtain reliable and valid information about pain, interference related to pain and satisfaction with care and with patient education approaches to pain management. Implications. Research with Hispanics is faced with challenges in study design, data collection and interpretation. Each phase demands attention to cultural values and careful validation by representatives of the target population. Research-based practice change regarding pain management in Hispanics is urgently needed. Results from this study provides a “state of the science” view of the Latino pain experience and is an important first step toward more effective intervention with a group vulnerable to inadequate pain management.
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