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

TL;DR

This study translated and shared pain management materials in Spanish to help hospices better support Spanish-speaking patients at the end of life.

Contribution

The study translated EMPOWER materials into Spanish and evaluated their use and usefulness in hospices with significant Hispanic patient populations.

Findings

Spanish EMPOWER materials were rated as more useful (8.4) than English materials (7.6) by hospice staff.

Most hospices indicated they would likely use EMPOWER materials in the future.

Thematic analysis showed EMPOWER helps address cultural barriers and supports clinical discussions about pain management.

Abstract

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.

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.

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 (n = 29), 58.6% indicated they—or another staff member—used them with patients or families. Using a single-item rating (0 = not useful to 10 = very useful), 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.

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.

Figures