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

为讲西班牙语的西班牙裔/拉丁裔癌症疼痛患者制定和实施适合文化的非阿片类疼痛应对技能培训干预

• 批准号: 10400340
• 负责人: GLENN J LESSER
• 金额: $ 58.12万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400340
• 关键词: Absence of pain sensation; Achievement; Address; Administrative Supplement; Advocate; American; Area; Award; Behavioral; Budgets; Cancer Pain Management; Cancer Patient; Cancer Survivor; Caring; Cause of Death; Cellular Phone; Clinic Visits; Clinical Trials; Collaborations; Communities; Community Clinical Oncology Program; Coping Skills; Critiques; Data; Development; Devices; Diagnosis; Disease; Educational Intervention; Effectiveness; English Language; Ethnic Origin; Ethnic group; Focus Groups; Funding; Future; Health; Health Services Accessibility; Helping to End Addiction Long-term; Hispanics; Improve Access; Individual; Internet; Intervention; Interview; Language; Latinx; Limited English Proficiency; Linguistics; Long-Term Care; Malignant Neoplasms; Methodology; Modification; National Cancer Institute; Not Hispanic or Latino; Oncology; Online Systems; Outcome; Pain; Pain management; Patients; Persistent pain; Personal Computers; Persons; Pharmacological Treatment; Pilot Projects; Population; Process; Quality of life; Race; Reporting; Research; Risk; Sampling; Services; Specific qualifier value; Stoicism; Tablet Computer; Testing; Training Programs; Translating; Translation Process; Translations; Travel; United States; United States National Institutes of Health; Validation; Work; acceptability and feasibility; base; bilingualism; cancer care; cancer health disparity; cancer pain; care systems; chronic pain; community organizations; cost; design; drug misuse; effective intervention; emotional distress; experience; handheld mobile device; healing; health literacy; low socioeconomic status; marginalized population; non-opioid analgesic; opioid misuse; pain relief; patient population; patient-clinician communication; personalized intervention; pilot trial; prevent; programs; psychosocial; skills training; social; treatment comparison; treatment effect; trial design

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.

摘要 尽管癌症仍然是美国西班牙裔/拉丁裔人口的主要死亡原因 西班牙裔/拉丁裔患者通常在癌症相关护理方面存在差异， 行为和心理社会肿瘤学研究继续关注非西班牙裔白人（NHW）。相比 对NHW来说，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）经历癌症相关护理不足，如疼痛 管理与其他种族和民族相比，西班牙裔/拉丁裔患者的疼痛程度也更高 组，并且更有可能表达对由于镇痛不足而导致的癌症疼痛管理的担忧， 疼痛缓解较少，以及患者与提供者之间的沟通较差。在所有疼痛管理中，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），以及无法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原发性疼痛的关键挑战 管理服务。西班牙语服务的严重缺乏，加上文化差异， 现有服务中的不一致，是与西班牙裔/拉丁裔接触的另一个障碍 社区.此外，还需要以西班牙语提供基于互联网的癌症护理服务， 格式化为通过移动的设备使用，这必须将独特的文化特征融入护理计划。 我们的团队已经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，保留了 经验验证和有效的个人PCST干预。PainTRAINER是一个最大限度的可访问， 互动和个性化的干预，不需要诊所访问或治疗师的参与。 PainTRAINER用于疼痛管理的有效性通过NIH资助的试验得到了很好的证实，但只有 在英语语言中，这在向讲西班牙语的患者提供护理的能力方面留下了空白， 精通英语。与西班牙裔和拉丁裔社区组织合作，社区咨询 董事会，病人倡导者和双语健康专家，我们将遵循一个逐步的社区参与， painTRAINER计划的文化适应和翻译，包括： 咨询委员会（CAB）和基于社区的方案审查小组（PRP）;进行初步干预 翻译过程;批判性地评估painTRAINER的核心功能和理论结构; CAB和PRP评估并进一步评论所有翻译;开发painTRAINER-西班牙语， 语言敏感和文化上适当;测试程序;并建立可行性和可接受性 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。