We don't talk about it: Cancer pain and American Indian survivors

Communication is an important part of the cancer experience. This paper reports on qualitative findings of a study looking at the pain experience of American Indian cancer patients and survivors, particularly in the areas of communication with family and healthcare providers. Analysis based on Grounded Theory techniques was used to assess the communication patterns of American Indian cancer patients/survivors residing in the Southwest. Twenty individual interviews and 13 focus groups examined key themes in cancer pain communication. The results were categorized into communication with nuclear/extended family members and communication with healthcare providers. Within these two categories, three themes emerged: (1) “we don't talk about it” (expectations not to burden others); (2) respect for healthcare providers (correcting or asking questions of providers is shameful); and (3) cancer experience is “meant to be” (fate cannot be altered). Cultural factors, such as perceptions of fatalism and respect for others, greatly influence the communication patterns of American Indian patients/survivors, resulting in the minimizing of reports and complaints regarding cancer pain. Understanding communication patterns and the reasons for reduced communication reported by cancer patients/survivors is important for healthcare providers, caregivers and others providing treatment and control of cancer pain.