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A National Online Forum on Ethnic Differences in Cancer Pain Experience

Im, Eun-Ok; Lee, Seung Hee; Liu, Yi; Lim, Hyun-Ju; Guevara, Enrique; Chee, Wonshik

doi: 10.1097/NNR.0b013e31818fcea4

Background: Cultural values and beliefs related to cancer and pain have been used to explain ethnic differences in cancer pain experience. Yet, very little is known about similarities and differences in cancer pain experience among different ethnic groups.

Objective: The objective of this study was to explore similarities and differences in cancer pain experience among four major ethnic groups in the United States.

Methods: A feminist approach by Hall and Stevens was used. This was a cross-sectional qualitative study among 22 White, 15 Hispanic, 11 African American, and 27 Asian patients with cancer recruited through both Internet and community settings. Four ethnic-specific online forums were conducted for 6 months. Nine topics related to cancer pain experience were used to guide the online forums. The collected data were analyzed using thematic analysis involving line-by-line coding, categorization, and thematic extraction.

Results: All participants across ethnic groups reported "communication breakdowns" with their healthcare providers and experienced "changes in perspectives." All of them reported that their cancer pain experience was "gendered experience." White patients focused on how to control their pain and treatment selection process, whereas ethnic minority patients tried to control pain by minimizing and normalizing it. White patients sought out diverse strategies of pain management; ethnic minority patients tried to maintain normal lives and use natural modalities for pain management. Finally, the cancer pain experience of White patients was highly individualistic and independent, whereas that of ethnic minority patients was family oriented.

Discussion: These findings suggest that nurses need to use culturally competent approaches to cancer pain management for different ethnic groups. Also, the findings suggest further in-depth cultural studies on the pain experience of multiethnic groups of patients with cancer.

Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, is Professor and La Quinta Motor Inns Inc. Centennial Professor, School of Nursing; Seung Hee Lee, PhD, MPH, is Postdoctoral Researcher, School of Nursing; Yi Liu, MSN, RN, is Doctoral Candidate, School of Nursing; Hyun-Ju Lim, MSN, RN, is Doctoral Candidate, School of Nursing; Enrique Guevara, MSN, RN, is Doctoral Candidate, School of Nursing; and Wonshik Chee, PhD, is Research Assistant Professor, College of Engineering, University of Texas at Austin.

Accepted for publication August 18, 2008.

This study was conducted as part of a larger study funded by the National Institutes of Health, National Institute of Nursing Research, National Cancer Institute (1 R01 NR007900).

The content is solely the responsibility of the authors and does not represent necessarily the official views of the National Institutes of Health.

Corresponding author: Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, School of Nursing, University of Texas at Austin, 1700 Red River, Austin, TX 78701 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.