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Original Article

Experiences of
Urban African Americans
with Cancer Pain
Angelika Maly, RN, MSN, ACNP,
---

Navdeep Singh, AGACNP-BC, MSN, CCRN,


and April Hazard Vallerand, PhD, RN, FAAN

- ABSTRACT:
The experience of cancer pain is poorly understood from the
perspective of African Americans, who experience higher levels of
pain, more pain-related distress, and poorer function than Cauca-
sians. Decreased perceived control over pain may play a greater role
for African American patients, affecting pain-related distress and
function. The purpose of this study was to add to the understanding of
cancer pain and perceived control over pain in African Americans,
from the patients’ perspective. This qualitative inquiry was part of a
larger mixed-methods study testing an intervention to improve pain,
pain-related distress, and functional status through increasing
perceived control over pain. Participants were recruited from the
waiting room of an urban comprehensive cancer and interviewed in
their homes. Interviews with 18 adult cancer patients who self-
identified as African American and reported experiencing moderate to
severe pain (>4 on a 0–10 scale) within the past two weeks were
included. Qualitative interviews were audiotaped, transcribed, and
analyzed using a constant comparative method. Two major themes
From the Wayne State University emerged from this qualitative inquiry: struggles of the chronic pain
College of Nursing, Detroit, Michigan. experience and benefits of perceived control over pain. Each theme
Address correspondence to Angelika contained several categories. The study unveiled the participants
Maly, RN, MSN, ACNP, Wayne State account of both struggles of the chronic pain experience and barriers
University College of Nursing, 5557 of perceived control that can be assessed for and targeted in nursing
Cass Avenue Building 319, Detroit,
MI 48202. E-mail: angelika.maly@
intervention. Benefits to having perceived control over pain were also
wayne.edu illustrated in the participants’ narratives.
Ó 2017 by the American Society for Pain Management Nursing
Received September 3, 2017;
Revised November 7, 2017;
Accepted November 9, 2017. African Americans face an undue burden of cancer pain (Green, Hart-Johnson, &
Loeffler, 2010) and yet the experience of cancer pain from the patients’ perspec-
This work was supported by the
National Cancer Institute Grant 1 tive is poorly understood. Cancer persists as a leading cause of death in the
RO1 CA149432-01A1. United States, with significant disparities in its diagnosis, treatment, and out-
comes (Green et al., 2010). Most (60%-85%) cancer patients experience moder-
1524-9042/$36.00 ate to severe pain after diagnosis, and nearly 40% report ongoing chronic pain
Ó 2017 by the American Society for
after the completion of treatment (Paice & Ferrell, 2011; Green et al., 2010).
Pain Management Nursing
https://doi.org/10.1016/ Many unscheduled hospital admissions of cancer survivors are attributed to
j.pmn.2017.11.007 uncontrolled pain both during and after treatment (Green et al., 2010).

Pain Management Nursing, Vol 19, No 1 (February), 2018: pp 72-78


Urban African Americans With Cancer Pain 73

Minorities are more likely to report poor health status, difficulty with accessing health care, may lead to feel-
often lack an established primary care provider, and ings of loss of control (Vallerand et al., 2007b).
have less access to specialists, even when health insur- Perceived control over cancer pain in individuals
ance and socioeconomic status are comparable to who experience racial and socioeconomic disparity is
those of Caucasians (Green et al, 2010). lacking (Vallerand, Templin, & Hasenau, 2016). The
Beliefs, attitudes, and expectations of the chronic purpose of this qualitative inquiry is to add to the un-
pain experience influence pain-related outcomes derstanding of cancer pain and perceived control
(Thompson, Broadbent, Bertino, & Staiger, 2015). over pain in African Americans with cancer.
Perceived control over pain, or the sense that one
has the ability to control pain, is partially composed
of these beliefs, attitudes, and expectations. In a study METHOD
of ambulatory patients with cancer pain, African Amer- Participants
icans were found to have higher levels of pain, more Following approval by the institutional review board, a
pain-related distress, and poorer function than Cauca- mixed-methods approach was used to test the Power
sian patients (Vallerand, Hasenau, Robinson-Lane, & over Pain–Coaching (POPC) intervention in a sample
Templin, in press). However, when perceived control of African Americans with cancer pain recruited from
over pain was controlled for across both groups, the the waiting room of an urban comprehensive cancer
differences in the outcomes of pain-related distress center in the Midwest (Vallerand et al., in press) This
and function were no longer significant, suggesting randomized control trial used a longitudinal repeated
that decreased perceived control over pain plays a measures design to test the efficacy of the POP-C inter-
greater role in African American patients (Vallerand, vention to improve pain, pain-related distress, and
Templin, Hasenau, & Riley-Doucet, 2007b). functional status by increasing perceived control over
Thompson (1981) suggested that control need only pain. Inclusion criteria consisted of self-identification
be perceived to have a positive influence on health out- as African American and moderate to severe pain
comes. Perceived control was later defined by Pellino ($4 on a 0-10 scale) within the past 2 weeks. The
(1997) as ‘‘the degree to which a person believes that 310 participants were primarily female with a mean
he/she has the power or ability to perform the age of 56 years, primarily unmarried, and the majority
behavior in question, and is influenced by factors were unemployed primarily because of disability or
such as time, skill, money, and others’ cooperation.’’ were disabled (Vallerand et al., in press). Additional de-
Perceiving a lack of control can be one of the most dis- tails on demographic data are provided in Table 1. Par-
tressing aspects of the pain experience. Vallerand et al. ticipants were randomized to either the control or
(2007b) found that in patients with cancer, control intervention group. A three-component intervention,
over pain has been suggested as more important than consisting of (1) Medication Management, (2) Pain
control over cancer itself. Barriers to effective pain Advocacy, and (3) Living with Pain, was delivered to
management, such as lack of knowledge of pain medi- patients in the intervention group in their homes
cation, inability to manage medication side effects, over a 5-week period. Quantitative and qualitative mea-
absence of caregiver support, financial burden, and sures were used to explain the effects of perceived
control over pain in this population. Qualitative meth-
odology using open-ended interviews and a phenome-
nological approach was used to seek a more in-depth
TABLE 1.
understanding of the experiences of urban African
Patient Demographics at Baseline (N ¼ 310)
Americans with cancer pain and as an added method
No. of Women 196 (63%) of evaluating the intervention. This article describes a
Age, years, mean (SD) 56 (11.42) preliminary report of the qualitative data.
Education, years, mean (SD) 12.29 (2.31)
Marital status, No.
Single 145 (46.8%) Data Collection, Analysis, and Management
Married 71 (21.3%) Participants were interviewed in their home during the
Separated (widowed or divorced) 99 (31.2%) course of the study. Qualitative interviews were audio-
Employment, No. taped and transcribed. Questions were used to guide a
Full or part time 48 (10.6%)
Retired 61 (19.5%) semistructured interview. Questions used include the
Unemployed 51 (16.9%) following:
Disabled 142 (44.9%)
1. Is pain control an issue or a problem for you?
Other 24 (8.3%)
2. Tell me what you do to control or manage the pain.
74 Maly, Singh, and Vallerand

3. How much control do you feel you have over your pain need for advocacy. Benefits of perceived control
and symptoms? over pain were described using the following cate-
4. Is it important to you to feel you have control in this gories: taking medications effectively, importance of
area? Why? function, and attitudes about perceived control over
5. What would help you to feel you had greater control pain.
over pain?
6. Did this program make a difference in the way you
Struggles of the Chronic Pain Experience
controlled your pain and symptoms?
Pain Intensity and Functional Status. The inter-
For this inquiry, initial interviews with 18 patients views captured the intensity of cancer-related pain in
enrolled in the larger study were reviewed for ‘‘clusters the stories the patients shared. One patient stated, ‘‘It
of meaning’’ to identify themes within the data was unbearable . it was excruciating . where I
(Creswell, 2013). After finding saturation for two major couldn’t move.’’ Often patients shared feelings of pain
themes in the initial 18 interviews, the decision was being so distressing that it made them believe life
made to publish this preliminary work prior to publish- was not worth living, as is reflected in the following
ing remaining findings from the larger sample. Line-by- comments: ‘‘I felt like I didn’t even want to live, the
line analysis (Miles & Huberman, 1994) was used to pain was so bad.’’ ‘‘I was in so much pain . I couldn’t
code, categorize, and analyze the data using NVivo bear it anymore that’s why I had to go to the hospital. If
Qualitative Data Analysis Software (Version 11, 2015; I could let somebody feel the pain, they would say how
QSR International, Melbourne, Australia). did you deal with this for so long and the only thing I
The interview transcripts were transcribed by could say is by the grace of God. I really wanted to
members of the research team, then checked for accu- die. I really meant that. I really wanted to die.’’
racy by the primary investigator. Transcripts were dou- Access to Health Care. Despite the severity of pain
ble coded by the primary investigator and two other that many of the patients in the study were experi-
designated team members. Double coding was utilized encing, they shared that access to a health care pro-
to enhance rigor. In addition, once the results of dou- vider was a common hurdle and sometimes they felt
ble coding were compared, interview data were re- help was unavailable. One patient stated, ‘‘I’m not
coded as needed to establish an intercoder reliability going to lie, the pain I was experiencing . I thought
of at least 70%. Transcription was ongoing throughout I couldn’t get any help from anyone . I was wishing
the data collection portion of the study, with transcrip- I was dead . it was that bad!’’ Many of the patients in-
tion occurring after each interview was completed. As terviewed simply could not access health care when
interviews are transcribed and coded, results of double they felt they needed it the most, as was indicated by
coding were compared, and the code list was refined a patient who stated, ‘‘I can’t see my doctor until
as needed based on the comparison of double coding. September and I want to see him.’’ Others felt there
Coded data were entered into an Excel file as a matrix were providers who would not treat the pain they
to allow for viewing of the full data set. Identification were experiencing and waited to be seen by another
of themes, patterns, and relationships between con- provider despite the persistence of severe pain, which
cepts followed using the matrix. Content analysis was the concern of a patient who reflected, ‘‘I’m wait-
was achieved using both within and across case anal- ing to see if she has a cancellation, I didn’t want to ask
ysis. Comparison of qualitative findings with quantita- my chemo doctor. I already asked them about the pain
tive findings was used to triangulate the data. Once medications.’’ At times, access to care was limited by
coding of all qualitative data from the larger participant age and access to the resources available under Medi-
sample is complete, a case summary will be written to care. This was the struggle for one patient whose inter-
summarize the data. Final results of the study will be vention nurse stated, ‘‘I was thinking you might be able
disseminated to relevant audiences. to get some help from Focus Hope, but you have to be
60 . but you are only 59.’’
Access to Medication. In addition to the obstacle of
RESULTS
accessing health care, obtaining prescriptions for opi-
Two major themes emerged from this qualitative in- oids to treat chronic, severe cancer pain added to the
quiry: struggles of the chronic pain experience and burden. Some patients shared that even after a pre-
benefits of perceived control over pain. Categories scription was written by a health care provider to
were identified within each of the two themes. Cate- address chronic pain, the challenge in filling prescrip-
gories used to describe struggles of the chronic pain tions was another hurdle. Financial concerns, adequate
experience included pain intensity and function, ac- transportation, and availability of opioids at urban
cess to health care, medication access, and the pharmacies were all issues commonly mentioned in
Urban African Americans With Cancer Pain 75

the interviews. Once contact was made with a health me feel bad . like I was making up something.’’ Still
care provider, obtaining adequate opioid therapy to others feared how they would advocate for pain man-
manage the cancer pain remained an issue because agement if the pain remained after the cancer treat-
of financial concerns. Prescriptions were cost prohibi- ment ended. One concerned patient stated, ‘‘they
tive, and for those who were insured, the co-pays re- said we’re not going to be able to give you this right af-
mained a hindrance to obtaining prescription ter you finish chemo.’’
opioids. One family member shared with the interven- Qualitative interviews gave insight into African
tion nurse, ‘‘haven’t been taking it because she can’t American cancer survivors’ struggles with the chronic
afford it.. That’s the other problem with medications; pain experience during cancer treatment. The patients
we don’t want to run out of them because we don’t struggled with overall pain intensity, function, access
know if we are going to be able to pay for them.’’ to health care as well as pain medication, and the
Cost concerns were often not evident in providers’ de- need for advocacy. The need for advocacy encom-
cisions in prescribing opioids. For example, when one passed the entire experience, including advocacy for
Medicaid insurance plan limited prescriptions for opi- a decreasing pain intensity, an increase in function, bet-
oids to 40 pills per month, the intervention nurse in ter health care access, access to pain medication, and
the study suggested that the patient request higher advocating for themselves.
doses of opioids prescribed in pill form so the pills
could be cut in half to increase the availability of doses. Benefits of Perceived Control over Pain
After discussing this with her health care providers, Taking Medications Effectively. In describing the
one patient shared, ‘‘They said they would give me benefits of perceived control over pain, patients
more pills, but not increase the strength.’’ Still other pa- shared their experiences with effectively taking pain
tients who were able to pay the cost of opioids were medications once they were equipped with adequate
met with resistance because of pharmacy and insur- knowledge to make decisions related to timing and
ance issues, as was evident in this patient’s statement, dose. Discussions between the patient and the inter-
‘‘The oxycodone . insurances don’t pay for it . her vention nurse addressed issues surrounding the
daughter asked the pharmacist how much the oxyco- importance of not waiting to take pain medications
done cost, and they responded, ‘$100.’’’ She replied, until the pain was severe and the ability of medica-
‘‘ ...Okay, I’ll just buy it.’’ However, the pharmacist re- tions to give the patient greater control over their
sponded, ‘‘No, if insurance doesn’t cover it . you pain and functional status rather than allowing the
can’t buy it.’’ pain to take the patient’s control away. One patient
Need for Advocacy. Coupled with the challenges of shared, ‘‘I was scared taking my medicines . I really
health care access, many patients had decreased ability was scared. If I hadn’t met you . and I just went to
to advocate for themselves. One patient shared, ‘‘I the doctor and he said, ‘just take the medicine’ and
went to the pain clinic, however never got seen by think everything will work out all right . and not
the doctor . waited 4 hours and then find out that I have some intricate knowledge of what’s going on
didn’t have an appointment.’’ Others who had the abil- . I’d still be in a lot of pain.’’.
ity to self-advocate were met with resistance or suspi- Importance of Function. Patients shared their im-
cion, as was reflected in this comment, ‘‘What really provements in overall function. One patient shared
made me mad was she was saying this is just in your with pride in his tone, ‘‘I can get around and move
head . I was very upset with her and that’s when I through here. This was something I wasn’t able to
knew I had to change the doctor.’’ The need for advo- do. I wanted to come down today and open the door
cacy was also apparent in reluctance to share the inten- for you and show you.’’ Improved function gave the pa-
sity of the cancer pain with family or friends, as was tients the ability to do what was meaningful and impor-
expressed by this patient who was still caring for her tant: ‘‘I wasn’t able to bend down and pick stuff up off
grandchildren each day while facing severe and persis- the floor. I’m able to do that now. I’m able to cook me a
tent pain, ‘‘I wouldn’t tell anybody . it was hard to feel meal pretty much without having to stop down in the
the way . but I didn’t tell my kids that it was that bad.’’ middle of the meal because I’m in such excruciating
Other patients shared feelings that the concerns they pain.. I’m able to get around and do stuff that I wasn’t
expressed with health care providers were not taken able to do.’’
seriously. As a patient shared her story, she stated, Attitudes About Perceived Control over Pain. In
‘‘They told me that they don’t believe that my joint describing the benefits of perceived control over
pain is from my chemo . my pain doctor told me pain gained from the intervention, patients described
that, he said I think it’s something else . he made their overall attitude, not only toward the chronic
76 Maly, Singh, and Vallerand

pain experience and underlying disease process, but team because of the profound ability their stories had
also toward life in general. One perspective shared to exemplify the true meaning of increasing a patient’s
often was that of not allowing themselves to be over- perception of control over the pain experience. An
come by the pain or not allowing the pain to dictate elderly African American gentleman battling chronic
how time was spent. One patient shared, ‘‘My doctor obstructive pulmonary disease (COPD) was one such
said, ’you’re an inspiration.’ He was surprised by me patient. He had been diagnosed with cancer and was
up and walking. He said most people are home in bearing the burden of considerable pain. He lived
bed. But I’m not going to let no pain get me.’’ One pa- alone, in a very modest but maintained inner-city apart-
tient also provided insight into the mindset developed ment. He was very kind, gracious, and proud despite
from the hardships associated with living in poverty his apparent struggles with inner-city life, advanced
and the attitudes people develop as a result. He shared age, and chronic disease. He was oxygen dependent
that, ‘‘it’s almost as if they [people living in poverty] and was not taking his prescribed pain medication
have a better ability to deal . because they’re used for fear it would stop his breathing. He shared that
to all these hardships . they’re used to challenges he only slept 2 hours each night because of his severe
. they are used to terrible things happening in their pain. Lack of sleep and fatigue from the unrelenting
life . it’s like cancer is just another one as opposed pain and COPD left him exhausted. The pain also
to other privileged people who get cancer, and you compromised his ability to care for himself, which
know it’s like the end of the world to them.’’ was difficult for him to accept because of the threat
Interviews provided insight into changes to his dignity as well as independence. Despite his
following increased perceived control over pain. struggles, his face always carried a smile and his eyes
Several patients shared a decreased reliance on hospi- always expressed joy when the intervention nurses
talization as a source of pain management. One patient made their visits. The intervention nurse spent a great
shared, ‘‘I’m thankful for you [the study intervention deal of time talking with him about his breathing and
nurses]. I’d probably be in the hospital right now if I his medication. The nurse taught him how to take
didn’t know what I know now.’’ Another patient stated, his medication so that it decreased his pain but did
‘‘I’ve been in the hospital at least seven times before I not affect his breathing. As the weeks of intervention
met you,’’ highlighting the extent to which emergency visits passed by, an increase in this patients’ perceived
room visits and hospitalization were viewed as the pri- control over the pain became quite evident. He slept
mary source for management of unbearable pain. better, his pain and fatigue decreased, and his energy
Another patient’s response reflected the level of improved. During one of the last visits, he met the
distress felt prior to gaining increased perceived con- nurses at the door, which was a first for him. At the
trol, ‘‘I had a long cry. I said ‘‘Lord, if I didn’t meet onset of that visit, he stated, ‘‘I wanted to come
them [the study intervention nurses], I probably down today and open the door for you and show
wouldn’t be alive.’’ Overall, patient responses to you that I wasn’t out of breath.’’ Over the course of
improved perceived control over pain and whether the intervention, an increased knowledge of effectively
the intervention made a difference in the way they using pain medications helped him control his pain
controlled their pain and symptoms was positive. and cope with his breathing problem. He shared, ‘‘I
One patient stated, ‘‘I’m so glad I’m in in this study; used to have a gray film over my face, and it’s clearing
you just brought a lot of things to my attention.’’ up literally. The stress level . my complexion . I’ve
Patients participating in the intervention gained noticed my complexion has really lightened up. I was
perceived control over pain to a greater degree as they really a light brown skinned man. All this pain I was
progressed through the study. Increased perception of having . I became a darker man.’’ Regarding effective
control over pain resulted in improved ability to take use of pain medications, he shared improvements in
prescribed medications effectively, improved functional the distress of the pain experience, ‘‘It was really
ability, and an improvement in attitude toward the can- educational, because I didn’t know that my pain med-
cer and associated chronic pain. This led to an overall ications were a help to my breathing. COPD had me
improved attitude toward the benefits of perceived con- real nervous about taking pain medications . espe-
trol over pain. cially when I sleep, if they were going to overdo me
. or be in a coma . or not wake up . whatever
One Patients’ Story the case may be.’’ With respect to his increased percep-
Many patients who shared their stories in the qualita- tion of control over pain he stated, ‘‘That’s what I really
tive interviews were memorable and reflected the po- needed to feel. Now since I’ve been with you guys .
wer of perceived control over pain. However, a few and I know that this medicine is not going to affect my
patients made a particularly strong impact on the study breathing . I take my medicine like I’m supposed to
Urban African Americans With Cancer Pain 77

and I feel GOOD.’’ For this patient and so many others, We identified limitations to this study. Because the
increased function was of great importance. This pa- study participants were limited to African Americans,
tient shared an example of his increased functional sta- results are less generalizable to other ethnic groups.
tus, ‘‘I feel a lot better . I’m able to go home (from In addition, participants included in the study experi-
hospital). I am able to do things that I wasn’t able to enced pain surrounding cancer treatment and diag-
do.’’ The patient describes his ability to cook himself nosis, limiting generalizability to pain experienced in
a meal rather than rely on fast food to meet his needs, the absence of cancer treatment.
‘‘With the little pain that I do have, I can go right
through it . and you know, I’m good. It was a task
Implications for Future Research
. first I got to get the pots, then I have to get the stuff
For many of the patients interviewed, the effect of pa-
out the refrigerator. I had to bring it to the table and sit
tients’ lifelong decreased perception of control, not
down with it. Now I’m able to get to the counter and
only over pain, but over other aspects of their lives,
make do. I can stand up now and cook the meal, before
was evident. The inconceivable wait time for a health
I had to sit down . then wait until I get some more
care provider experienced by one patient, only to
energy to get the rest of the stuff. I would take breaks
discover she did not even have an appointment, is
and then go back. Chopping onions, it would take me
one example. This begs the question of whether the
to a lot of time. It would take me 4-5 hours to cook
perceived control over pain in this study was an awak-
lunch and now it only takes me 2 hours.’’ The patient
ening for some patients, reminding them that control
also described how increased perceived control felt,
was attainable. Recommendations for the future would
and the intervention nurses witnessed an exemplary
then be to incorporate interventions that increased
account of what increased perceived control looks
perceived control over pain, as well as increase
like in the joy he had in his face when he met the inter-
perceived control over other disease processes.
vention nurses at the door for his last visit while
Increased perception of control has been achieved
enrolled in the study. Despite having access to pain
through interventions that include coaching for
medication, education about his diseases, taking his
increased self-advocacy during patient-provider inter-
pain medication, and preventing and managing of
actions, as well as teaching to allow for increased
side effects was essential to safely managing this pa-
self-management of the pain management regimen
tient’s pain and improving his perception of control
(Vallerand, et al., in press). Perhaps, increasing the
over pain.
perception of control would lead to improved disease
outcomes in much the same way that pain was
improved in this study.
DISCUSSION
For those who lack a sense of control, catastroph-
The results of this study identified the predominant izing, or negative coping, may be a predominant
themes of struggles with chronic pain and the benefits response to chronic pain. Sufferers of chronic pain
of perceived control over pain in African Americans who cope negatively, often respond with an increased
with cancer pain. The major struggles were focused focus on the pain experienced, coupled with feelings
on pain intensity and functional status, access to health of helplessness and often increased disability
care and pain medications, and the need for advocacy. (Gauthier, Thibault, & Sullivan, 2011; Vallerand et al.,
Participants’ discussions about the benefits of having 2016). Assessment of coping strategies in relation to
perceived control over pain concentrated on taking both chronic pain and chronic disease and how
medications effectively, the importance of function, coping strategies influence perceived control over
and attitudes about perceived control over pain. pain may be an area for future investigation.
Assessment of perceived control over pain may be
as important in achieving positive pain-related out- Implications for Nursing
comes as assessing the level of pain intensity, but little The comprehensive nature of pain assessment can be
attention has been given to perceived control as it re- improved by including an assessment of perceived
lates to pain (Vallerand et al., 2007b). Loss of control control over pain. The simple question ‘‘How much
through both an inability to effectively manage pain in- control do you feel that you have over your pain?’’
tensity and diminished function is a distressing factor can easily be used to assess the patient’s perception
of chronic pain shared in this study. Difficulty in access- and plan nursing interventions that increase the pa-
ing both health care and medication access was a tient’s perceived control over pain. Other studies
burden that patients shared with the intervention have found that as perceived control over pain
nurses at virtually every visit. increased, improvements in overall mental well-being
78 Maly, Singh, and Vallerand

improved as well (Vallerand et al., in press). Thus, Examples of nonpharmacological adjunctive interven-
perceived control over pain should be a principal tions can include heat or cold application, relaxation
part of pain assessment. techniques, and at times even exercise. Lastly, making
Nurse-centered interventions for increasing sure the patient knows when and how to contact the
perceived control over pain should be incorporated clinician if medications are not working or if side ef-
into the care of each patient suffering pain. In this fects develop is essential. Nurses have a unique ability
study, the positive effects of increasing patients’ within the trusting nurse-patient relationship to influ-
knowledge of pain management strategies illustrated ence the patient’s perceived control over pain and
the positive impact that education has on the patient’s lessen the burden of the pain experience for the
pain experience. In addition to education, numerous patient.
approaches to improving perceived control over pain
have been suggested in the literature (Vallerand,
Saunders, & Anthony, 2007a). One example is allowing
CONCLUSIONS
patients greater control over the pain management
regimen and dosage changes that address the unpre- This qualitative study examined the perspectives of
dictable and dynamic nature of pain. Providing the pa- African American patients with cancer pain. Within
tient with greater control over pain management the themes of struggles of the chronic pain experience
begins with both advocacy for the patient by the nurse, and benefits of perceived control over pain, the
as well as teaching the patient how to advocate for patients provided narratives of the pain experience.
themselves to increase overall perceived control of This qualitative inquiry contributes to the understand-
pain. The use of nonpharmacological pain manage- ing of the patients’ perspective of cancer pain and
ment strategies, as used in the POP-C study interven- perceived control over pain in African Americans
tion, may also be beneficial as adjunctive therapy. with cancer.

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