Developing and Implementing a Culturally Appropriate Non-Opioid Pain Coping Skills Training Intervention for Spanish-Speaking Hispanic/Latinx Patients with Cancer Pain

摘要 尽管癌症仍然是美国拉美裔/拉丁裔人口的主要死亡原因 西班牙裔/拉丁裔患者在癌症相关护理方面经常存在差异，绝大多数 行为和心理社会肿瘤学的研究继续关注非西班牙裔白人(NHW)。相比较 对于nhw来说，认为自己是西班牙裔和拉丁裔的人更有可能：1)被诊断为晚期 疾病，2)生活质量差，3)癌症相关护理不足，如疼痛 管理层。与其他种族和民族相比，西班牙裔/拉丁裔患者也承受更大程度的痛苦 他们更有可能对由于止痛不足而导致的癌症疼痛管理表示担忧， 疼痛缓解较少，患者与提供者之间的沟通不畅。在所有的疼痛管理中，西班牙裔/拉丁裔 与其他人群相比，人群获得慢性疼痛治疗的机会较少(特别是如果他们主要是 西班牙语)，没有足够的机会获得适当的疼痛治疗，这可能有助于药物治疗 滥用、情绪困扰和生活质量下降。除了社会决定的差异外，语言 障碍是限制药物治疗依从性和获得基本疼痛的关键挑战 管理服务。西班牙语服务的严重缺乏，再加上文化因素 现有服务中的不协调是与西班牙裔/拉丁裔接触的额外障碍 社区。此外，还需要以西班牙语和英语提供基于互联网的癌症护理服务。 通过移动设备格式化使用，移动设备必须将独特的文化特征整合到护理计划中。 我们的团队开发并验证了基于网络的疼痛应对技能培训(PCST)干预 (PainTRAINER)，可通过支持互联网的设备和智能手机获得，它保留了 经经验验证的、有效的面对面PCST干预。PainTRAINER是一款最容易接近的， 互动式个性化干预，无需就诊或治疗师参与。 PainTRAINER对疼痛控制的有效性通过NIH资助的试验得到了很好的证实，但只有 在英语中，这在向讲西班牙语的有限患者提供护理的能力方面留下了空白 英语熟练程度。与西班牙裔和拉丁裔社区组织合作，社区咨询 董事会、患者权益倡导者和双语健康专家，我们将遵循一个循序渐进的社区参与和 PainTRAINER计划的文化知识改编和翻译，包括：建立一个社区 咨询委员会(CAB)和以社区为基础的方案审查小组(PRP)；执行初步干预 翻译过程；批判性地评估PainTRAINER的核心功能和理论构建；参与 CAB和PRP对所有翻译进行评估和进一步批评；开发PainTRAINER-西班牙语 语言敏感度和文化适宜性；测试计划；确定可行性和可接受性 在患有持续性癌症相关疼痛的西班牙裔/拉丁裔患者中新产生的干预措施。

ABSTRACT Though cancer remains a leading cause of death among Hispanic/Latinx populations in the United States and Hispanic/Latinx patients routinely experience disparities in cancer-related care, the overwhelming majority of behavioral and psychosocial oncology research continues to focus on non-Hispanic whites (NHW). Compared to NHW, individuals who identify as Hispanic and Latinx are more likely to: 1) be diagnosed with advanced stage disease, 2) experience poor quality of life, and 3) experience inadequate cancer-related care such as pain management. Hispanic/Latinx patients also endure greater levels of pain compared to other racial and ethnic groups, and are more likely to express concerns about cancer pain management due to inadequate analgesia, less pain relief, and poor patient-provider communication. Across all of pain management, Hispanic/Latinx populations have lower access to chronic pain treatments compared to others (particularly if they are primarily Spanish speaking), and inadequate access to suitable pain treatments, which may contribute to medication misuse, emotional distress, and diminished quality of life. In addition to socially determined disparities, language barriers are a key challenge limiting compliance with pharmacologic treatments and access to essential pain management services. The overwhelming lack of services available in Spanish, compounded by cultural discordance within available services, serves as an additional barrier to engagement with Hispanic/Latinx communities. Additionally, there is a need for internet-based cancer care services provided in Spanish and formatted for use via mobile devices, which must integrate unique features of culture into care programs. Our team has developed and validated a web-based pain coping skills training (PCST) intervention (painTRAINER), available via Internet-enabled devices and smart phones, that retains critical features of empirically validated and effective in-person PCST interventions. PainTRAINER is a maximally accessible, interactive and personalized intervention that does not require clinic visits or therapist involvement. PainTRAINER’s effectiveness for pain management is well-established via NIH-funded trials, but is only available in the English language which leaves a gap in the ability to extend care to Spanish-speaking patients with limited English proficiency. In collaboration with Hispanic and Latinx community organizations, community advisory boards, patient advocates, and bilingual health experts, we will follow a stepwise community-engaged and culturally-informed adaptation and translation of the painTRAINER program including: develop a community advisory board (CAB) and a community-based programmatic review panel (PRP); perform an initial intervention translation process; critically evaluate core functions and theoretical constructs of painTRAINER; engage the CAB and PRP to evaluate and further critique all translations; develop painTRAINER-Spanish to be both linguistically sensitive and culturally appropriate; beta test the program; and establish feasibility and acceptability of the newly generated intervention among Hispanic/Latinx patients with persistent cancer-related pain.