The Thai cancer pain experience: Relationships among spiritual beliefs, pain beliefs, pain appraisal, pain coping, and pain perception and outcomes

Cancer is the second leading cause of death in Thailand. Approximately 18,000 die from cancer every year and more than 70% of these people die in pain without proper pain management. There has been only a limited number of studies of the Thai cancer population investigating the role of beliefs and Thai cultural influences on the use of coping strategies by the cancer population. The purpose of this study is to gain a better understanding of the cancer pain experience in Thai patients with cancer by examining the relationships among pain beliefs, perceived meaning of cancer pain, perceived control over pain, coping strategies, spiritual beliefs, and pain perception and pain related outcomes (pain intensity and pain interference) and to test a proposed theoretical model for the Thai cancer pain experience.;An exploratory descriptive design was used in this study, along with seven instruments: the Biobehavioral Pain Profile (BPP), the Briefs Spiritual Beliefs Inventory (SBI), the Perceived Meaning of Cancer Pain Inventory (PMCPI), the self-efficacy scale of the original coping strategies questionnaire, the Revised Coping Strategies Questionnaire (CSQ-R), the Brief Pain Inventory (BPI) and the Demographic Information and Pain History Forms. All of the instruments were translated and back-translated from Thai to English and showed satisfactory psychometric properties. Data were interpreted through by using the bivariate correlational analysis and structural equation modeling techniques.;Two hundred and sixty-five cancer patients from three hospitals of two regions---Northern and Central parts of Thailand---agreed to participate in the study. The research question of the relationships among variables was answered. The proposed structural model was tested. Based on the result demonstrated throughout the analytical processes, the examination of sixteen initial models lead to an acceptable initial pain model (model A) and the modification in the subsequent structural equation modeling analyses (the reduced model B-1 and the alternative model C-1). The best representative model for the Thai cancer pain experience was selected on the basis of two considerations: (1) whether is it theoretically interpretable, and (2) whether the model fit the data based on the fit indices.;By including pain beliefs and spiritual beliefs in the study model, a better understanding of the role of culturally related factors and religious beliefs in the cancer pain experience was achieved. Moreover, this study provides another evidence for the differences of coping strategies use between Western and Eastern people. This study result also demonstrates that catastrophizing plays essential roles in pain related outcomes. However, this study is only at the exploratory phase, and future studies are recommended to validate the finding and to examine in greater depth the Thai cancer pain experience.