When considering the lack of comparative studies on cancer pain experience among the four major ethnic groups of cancer patients in the US, the study presented in this paper certainly adds new information to the current literature. Yet, despite the paucity of the literature on this topic, some of the findings reported in this paper agree with previous findings of the few studies that have taken place. First, the themes representing the commonalities in cancer pain experience across ethnic groups that are reported in this paper agree with previous findings in the literature. The themes of communication breakdown
and gendered experience
affirm the findings of previous studies (Chan & Woodruff, 1997
; Laliberte, 2003
). Indeed, the previous studies have reported that miscommunication was a major reason for inadequate cancer pain management, especially for ethnic minority cancer patients; and that, across the ethnic groups, women were the ones who should shoulder the burdens of household tasks despite their diseases. The second theme representing the commonalities in cancer pain experience across ethnic groups, changes in perspectives
, also agrees with findings of the few previous studies. The studies have reported cancer patients’ adjustment process and transcendent experiences throughout the adjustment process, which frequently results in changes in perspectives (Fatone et al., 2007
; Foley et al., 2006
). The specific changes in perspectives according to ethnicity (that are reported in this study) also agree with the findings of previous studies (Green et al., 2003
; Pinquart & Sorensen, 2005
). Among White participants, the changes in their perspectives were for control of their own bodies, diseases, and lives; among ethnic minority participants, the changes in perspectives focused on the welfare of their families.
The findings reported in this paper add new information to the current literature as well. The first theme of the differences in cancer pain experience among the four ethnic groups, controlling versus minimizing
, reflects how differently cultures view cancer and cancer pain, which has been reported rarely in the literature. Most White participants viewed cancer as a chronic condition that they could overcome by controlling their own bodies and disease processes, while ethnic minority participants tried to minimize their pain because of the stigmatized nature of cancer in their culture, their cultural stoic attitudes toward pain, or both. These ethnic differences may come from cultural differences among the four ethnic groups. First of all, individualism embedded in White culture view individualists as having control over and taking responsibility for their actions (Green et al., 2003
), which might make White participants focus on how to control their pain and bodies. African American culture that stigmatizes cancer as a contagious disease, God’s punishment for improper behavior or not living according to his will, or the work of the devil (Bailey, Erwin, & Belin, 2000
) might make African American people hide their disease and minimize their pain. Machismo
, a Hispanic cultural feature (which instructs that men should be strong and in control and help meet the needs of the family), and Hispanic cultural values that emphasize women’s sacrifice for their families and the importance of motherhood (De Pheils & Jaramillo, 2003
) might make Hispanics behave stoically toward pain. Finally, Asian culture based on Confucianism and Taoism in which stoicism is valued highly (Chung, Wong, & Yang, 2000
) might inhibit them from expressing pain as well as other potentially disruptive and distressing emotions including fear, anxiety, sadness, or anger.
The second theme representing the differences in cancer pain experience among the four major ethnic groups, searching for versus naturalizing
, highlights cultural differences in cancer pain experience, which adds new information to the current literature. This study indicated that White participants were searching for better treatment of cancer and management of pain while ethnic minority cancer patients tried to naturalize their pain and tolerate as much pain as they could. These findings have been reported episodically in the literature, but they tend to be limited to a specific ethnic group in each individual study (Ashing-Giwa et al., 2006
). Interestingly, naturalizing cancer and pain was much more prominent among the Asian participants compared with other ethnic groups. Through acting normally, Asian participants tried not to give cause to worry or to be burdens to their families. This might also result in the prevalent use of complimentary and alternative medicine (CAM) among Asian participants because CAM emphasizes that negative attitudes lead to negative behavior patterns that result in cancer (Im, 2000
The third theme representing differences in cancer pain experience among the ethnic groups, individualized versus family oriented
, also adds new distinction to ethnic differences in cancer pain experience. These findings can also be linked to individualism in White culture and to collectivism in African American, Hispanic, and Asian culture (Gonzalez, Gallardo, & Bastani, 2005
; Pinquart & Sorensen, 2005
). Because of their individualistic cultural background, White participants experienced and managed their pain independently of family members. Also, because of their collectivistic cultural background, ethnic minorities tended to depend on their families in their cancer pain management process.
The findings of the study reported in this paper have several limitations. First of all, the study is limited in its generalizability because the participants were recruited using a convenience sampling method and the data collection was done through the Internet. Subsequently, participants might not fully represent diverse groups of cancer patients within each ethnic group because of inherent characteristics of a convenience sampling method. Indeed, the participants tended to be highly educated cancer patients who were willing to use a computer and the Internet and who were able to type. In addition, the participants in each ethnic group did not represent all sub-ethnic groups within each ethnic group. For example, a majority of the Asian participants were foreign-born Chinese cancer patients and did not represent subethnic groups of Asians in the US adequately.
Conclusions and Implications
Based on the findings, the following recommendations for future research and health care practice with cancer patients from multiethnic groups in the US are offered. First of all, nurses should be aware of cultural differences in cancer pain experience and use culturally competent approaches to cancer pain management for different ethnic groups of cancer patients. Cultural competence refers to the acknowledgment and affirmation of cultural sensitivity embedded in cultural knowledge (Spector, 2000
). As the findings of the study reported in this paper indicated, the cancer pain experience of each ethnic group was unique and culturally embedded. As the IOM recommended (2002), increasing awareness of disparities in cancer pain management due to cultural differences in cancer pain experience should come first among nurses.
Second, more in-depth studies on subethnic variations in each major ethnic group are needed. As mentioned above, the participants of the study reported in this paper might not represent diverse ethnic groups of cancer patients in the US. When considering various subethnic groups within each major ethnic group and the unique cultural background of each subethnic group, more in-depth studies on subethnic variations are essential for a comprehensive understanding of cancer pain experience in the US and for culturally competent cancer pain management. As Ho (2000)
asserted based on the work of the Asian American Network for Cancer Awareness, Research, and Training, further exploration especially on Asian cancer patients’ pain experience is needed because very little is still known about their cancer pain experience and because subethnic variations among this population are much more prominent than other major ethnic groups (more than 30 subethnic groups among Asians in the US).
Finally, more in-depth cultural studies on cancer pain experience among diverse gender, ethnic, and socioeconomic groups are needed to develop a cultural knowledge base of cancer pain experience. As discussed above, the participants of the study reported in this paper tended to be a select group of cancer patients. Thus, the recommendations by the Agency for Healthcare Research and Quality (AHRQ; 2008
) are echoed here: further studies on the cancer pain experiences of diverse gender, ethnic, and socioeconomic groups of cancer patients are essential for continuous development of cultural knowledge that will provide directions for culturally competent care for ethnic minority cancer patients in the US.