Barriers to Pain Care Among First-generation Chinese-Americans: What Can be Done?
Lara K. Dhingra, PhD
Attending Psychologist
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center
Assistant Professor of Neurology and Psychiatry and Behavioral Sciences
Albert Einstein College of Medicine
New York, New York
New York City has a large population of recent Chinese-Americans. As a group, these individuals are often economically disadvantages, medically underserved, and have very high rates of certain cancers. Among those with cancer-related pain, most have frequent or persistent pain, and few are receiving effective pain management. Many do not take any pain medication, and among those who do, many do not know what type of medication they are taking. These problems, observed in recent Chinese immigrants in New York, are also likely to be found in other immigrant groups.
Among these first-generation Chinese-Americans, many barriers exist to care. Financial barriers are large – many in this group live below the poverty line – as are language barriers – many speak only limited English, if any. There are additional, cultural barriers to pain care. Many first-generation Chinese-Americans have been taught, based on Confucianism, that to show any emotion, including pain, is a sign of weakness. Further, there may be a sense of both religious and cancer-specific fatalism which may be a barrier to care. It is often felt that pain should be endured for spiritual reasons, and that using pain medication may result in continued pain in the afterlife. Cancer also carries a significant stigma; patients may feel uncomfortable discussing their diagnosis and may feel that pain is an inevitable outcome of cancer, and thus not worth mentioning.
In situations such as these where there are language barriers to assessment and treatment, clinicians can utilize pain scales which have been translated and validated in other languages, such as the BPI. Visual scales, such as the faces scale, and observation of pain behaviors can also contribute valuable information. While financial barriers can be significant, there may be other underutilized resources, such as social workers, available to help patients gain access to the care they need.
Barriers to Pain Care Among First-generation Chinese-Americans: What Can be Done?
Lara K. Dhingra, PhD
Attending Psychologist
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center
Assistant Professor of Neurology and Psychiatry and Behavioral Sciences
Albert Einstein College of Medicine
New York, New York
New York City has a large population of recent Chinese-Americans. As a group, these individuals are often economically disadvantages, medically underserved, and have very high rates of certain cancers. Among those with cancer-related pain, most have frequent or persistent pain, and few are receiving effective pain management. Many do not take any pain medication, and among those who do, many do not know what type of medication they are taking. These problems, observed in recent Chinese immigrants in New York, are also likely to be found in other immigrant groups.
Among these first-generation Chinese-Americans, many barriers exist to care. Financial barriers are large – many in this group live below the poverty line – as are language barriers – many speak only limited English, if any. There are additional, cultural barriers to pain care. Many first-generation Chinese-Americans have been taught, based on Confucianism, that to show any emotion, including pain, is a sign of weakness. Further, there may be a sense of both religious and cancer-specific fatalism which may be a barrier to care. It is often felt that pain should be endured for spiritual reasons, and that using pain medication may result in continued pain in the afterlife. Cancer also carries a significant stigma; patients may feel uncomfortable discussing their diagnosis and may feel that pain is an inevitable outcome of cancer, and thus not worth mentioning.
In situations such as these where there are language barriers to assessment and treatment, clinicians can utilize pain scales which have been translated and validated in other languages, such as the BPI. Visual scales, such as the faces scale, and observation of pain behaviors can also contribute valuable information. While financial barriers can be significant, there may be other underutilized resources, such as social workers, available to help patients gain access to the care they need.
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