Pain and social processes for hospice cancer patients: An integrative review

- Cancer pain management involves complex social processes for patients and others.
- Pain meaning and control behaviors are social processes identified in studies.
- Pain meanings and goals vary for persons with cancer, caregivers, and nurses.
- Differences in cancer pain social processes create or act as pain control barriers.
- Research is needed to develop clinical social processes pain assessment tools.

PurposeHospice cancer patients experience poorly-controlled pain in spite of widely-disseminated evidence-based guidelines for use by hospice care practitioners. Pain management occurs in the context of the interdisciplinary team, centered on a caring triad in the home: the person with pain, their caregiver, and their nurse. This review: 1) Summarizes what is known about differing ways that members of the hospice caring triad (patients, caregivers, and nurses) interpret and respond to cancer pain, in order to develop a cancer pain social processes theoretical framework, 2) Identifies gaps in understanding of hospice cancer pain social processes, and 3) Identifies framework concepts for research-based clinical practice with potential to improve pain outcomes.MethodsOur integrative review of the literature resulted in the identification and synthesis of 21 unique studies of cancer pain social processes, which were categorized according to a social processes framework and hospice caring triad member roles, using a social processes concepts matrix.ResultsPain meanings, goals, and related responses vary for persons with pain, caregivers, and nurses. Studies have explored individual social processes concepts or triad member roles. Studies identify the need for pain meaning to be included in hospice pain management plans.ConclusionsTo our knowledge, no single study has generated a framework for hospice cancer pain social processes addressing and incorporating the roles of all three caring triad members. Therefore, comprehensive hospice cancer pain clinical evaluation and interventions plans may be missing key elements of pain management, especially for persons with ongoing poorly controlled pain.