Spanish Translation and Dissemination of EMPOWER Materials to Address Barriers to Pain Management at the End of Life

Overview

Journal Palliat Med Rep

Specialty Critical Care

Date 2024 Apr 26

PMID 38665226

Authors

John G Cagle

Iraida Carrion

Todd D Becker

Peiyuan Zhang

Affiliations

Soon will be listed here.

Abstract

Introduction: The Effective Management of Pain by Overcoming Worries to Enable Relief (EMPOWER) intervention is an evidence-supported approach for addressing barriers to pain management (e.g., patient/family concerns about addiction) at the end of life. Such barriers appear more pronounced among Spanish-speaking individuals. This study aimed to (1) translate EMPOWER materials into Spanish, (2) disseminate materials to hospices with ≥25% Hispanic patients, and (3) survey hospices about the use and usefulness of materials.

Methods: We back translated EMPOWER materials with harmonization, then disseminated materials to 242 hospices. Thereafter, we used a semistructured survey to assess use and usefulness of EMPOWER materials using univariate statistics and content analysis.

Results: Thirty-eight hospice representatives responded (participation rate = 15.7%). Respondents were primarily non-White (55.3%) and Hispanic (60.5%). Nealy half (47.4%) were nurses. A majority (81.6%) indicated they currently employ ≥1 full-time English-Spanish bilingual team member. Among those who reported receiving the EMPOWER materials ( = 29), 58.6% indicated they-or another staff member-used them with patients or families. Using a single-item rating (0 = to 10 = ), respondents evaluated the English EMPOWER materials' usefulness as 7.6 (standard deviation [SD] = 1.4) and Spanish materials as 8.4 (SD = 1.4). Most (62.1%) indicated they would likely use EMPOWER materials in the future.

Conclusion: Thematic findings suggest EMPOWER reinforces clinical education, promotes discussion about pain management, and helps address culturally specific barriers to care. EMPOWER appears to be a useful, easy to use, and promising intervention that can be implemented among both English- and Spanish-speaking populations.

References

Starr L, Washington K, Jabbari J, Benson J, Parker Oliver D, Demiris G . Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation. Am J Hosp Palliat Care. 2023; 41(6):619-633. PMC: 11032627. DOI: 10.1177/10499091231191114. View

Parker Oliver D, Wittenberg-Lyles E, Demiris G, Washington K, Porock D, Day M . Barriers to pain management: caregiver perceptions and pain talk by hospice interdisciplinary teams. J Pain Symptom Manage. 2008; 36(4):374-82. PMC: 2581443. DOI: 10.1016/j.jpainsymman.2007.11.005. View

Zapata C, Poore T, ORiordan D, Pantilat S . Hispanic/Latinx and Spanish Language Concordance Among Palliative Care Clinicians and Patients in Hospital Settings in California. Am J Hosp Palliat Care. 2023; 41(1):73-77. PMC: 10709994. DOI: 10.1177/10499091231171337. View

Randall-David E, Wright J, Porterfield D, Lesser G . Barriers to cancer pain management: home-health and hospice nurses and patients. Support Care Cancer. 2003; 11(10):660-5. DOI: 10.1007/s00520-003-0497-x. View

Cagle J, Van Dussen D, Culler K, Carrion I, Hong S, Guralnik J . Knowledge About Hospice: Exploring Misconceptions, Attitudes, and Preferences for Care. Am J Hosp Palliat Care. 2014; 33(1):27-33. DOI: 10.1177/1049909114546885. View

Adam Herbstsomer R, Stahl S . Cross-Cultural Experiences of Hospice and Palliative Care Services: A Thematic Analysis. Omega (Westport). 2020; 84(2):551-566. DOI: 10.1177/0030222820904205. View

Cagle J, Zimmerman S, Cohen L, Porter L, Hanson L, Reed D . EMPOWER: an intervention to address barriers to pain management in hospice. J Pain Symptom Manage. 2014; 49(1):1-12. PMC: 5512875. DOI: 10.1016/j.jpainsymman.2014.05.007. View

Carey T, Freburger J, Holmes G, Jackman A, Knauer S, Wallace A . Race, care seeking, and utilization for chronic back and neck pain: population perspectives. J Pain. 2009; 11(4):343-50. PMC: 2847652. DOI: 10.1016/j.jpain.2009.08.003. View

Becker T, Cagle J . Priority Research Topics and Patient and Family Needs in a National Sample of Hospice Agencies. J Pain Symptom Manage. 2022; 65(2):133-142. DOI: 10.1016/j.jpainsymman.2022.10.009. View

10.

Bruneau J, Moralejo D, Donovan C, Parsons K . Recruitment of Healthcare Providers into Research Studies. Can J Nurs Res. 2021; 53(4):426-432. DOI: 10.1177/0844562120974911. View

11.

Spencer M, Minino A, Warner M . Drug Overdose Deaths in the United States, 2001-2021. NCHS Data Brief. 2023; (457):1-8. View

12.

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A . Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005; 8(2):94-104. DOI: 10.1111/j.1524-4733.2005.04054.x. View

13.

Portenoy R, Ugarte C, Fuller I, Haas G . Population-based survey of pain in the United States: differences among white, African American, and Hispanic subjects. J Pain. 2004; 5(6):317-28. DOI: 10.1016/j.jpain.2004.05.005. View

14.

Hong S, Cagle J, Van Dussen D, Carrion I, Culler K . Willingness to Use Pain Medication to Treat Pain. Pain Med. 2015; 17(1):74-84. DOI: 10.1111/pme.12854. View

15.

Carrion I, Cagle J, Van Dussen D, Culler K, Hong S . Knowledge About Hospice Care and Beliefs About Pain Management: Exploring Differences Between Hispanics and Non-Hispanics. Am J Hosp Palliat Care. 2014; 32(6):647-53. DOI: 10.1177/1049909114536023. View

16.

Cagle J, Bunting M . Patient Reluctance to Discuss Pain: Understanding Stoicism, Stigma, and Other Contributing Factors. J Soc Work End Life Palliat Care. 2017; 13(1):27-43. DOI: 10.1080/15524256.2017.1282917. View