Breaking barriers: Cancer Pain Management and Healthcare Access for Migrants and Refugees -- A scoping review protocol

Pain is a common symptom of a cancer diagnosis and rises in prevalence throughout and beyond cancer treatment. The prevalence of cancer-related pain is 35.8% after curative treatment, 54.3% in patients receiving palliative treatment and 54.6% in patients with advanced, metastatic or terminal disease. Chronic pain reduces cancer patients’ quality of life and is associated with employment-related challenges and increased financial hardship. Additionally, continuity and coordination with healthcare professionals is often difficult across the course of cancer treatment and it is not clear who is directly responsible for pain management. Additionally, continuity and coordination with healthcare professionals is often difficult across the course of cancer treatment and it is not clear who is directly responsible for pain management. As inadequate cancer pain control is a problem that has prevailed over the years, research that explores barriers to pain management and strategies to enhance pain control are essential to decrease the burden associated with inadequate pain management and the resulting decrease in quality of life (QOL). Levesque et al. (2013) define access to health care as “the possibility to identify healthcare needs, to seek healthcare services, to reach the healthcare resources, to obtain or use health care services, and to actually be offered services appropriate to the needs for care” . People from refugee and immigrant backgrounds often face exclusion and discrimination, which affects their ability to integrate into healthcare systems. As a result, migrants feel that their pain concerns or questions are not accurately conveyed, which generates miscommunication, frustration and further treatment delays. Financial burden and lack of insurance may also affect access to cancer pain management due to affordability concerns. Finally, cultural particularities influencing on individual cancer pain experiences significantly influence pain management behaviours (e.g. fear of “addiction”, mistrust, or concerns about side effects). Due to the scarce literature regarding interventions aimed at migrants' and refugees’ access to non-cancer chronic pain management in healthcare settings (e.g. psychological, educational, physical therapy, culturally-adapted information), and, the lack of evidence evaluating cancer-related pain management in these populations, we aim to conduct a scoping review exploring access to cancer-related pain management for immigrants in the healthcare setting. Furthermore, we aim to underscore the importance of the prioritization of cancer-related pain management in healthcare planning to enhance the well-being of immigrant cancer patients and survivors. The planned scoping review will aim to answer the following question: - What is the range of interventions aimed at improving access and utilization of cancer-related pain management services in healthcare settings for migrants and refugees? Inclusion criteria: Population: We will include interventions designed for populations of all ages, who are persons from culturally diverse backgrounds such as emigrants and immigrants. These populations are defined as the people who leave their place of residence in one country and settle in a different country. Visitors, international students, temporary workers, asylum seekers, economic immigrants, refugees, sponsored families, protected persons, permanent resident humanitarian grounds, are included in these populations. We will include interventions aimed for people who self-reported current or past presence of cancer-related pain and/or current or past treatment (pharmacological or non-pharmacological) for cancer-related pain. Concept: We will examine interventions or strategies to improve access to cancer-related pain management (pharmacological and non-pharmacological). These interventions include: educational, peer education and support, social marketing and behavioral change campaigns, healthcare workforce technical training, cultural competency training of health staff, training of lay health workers, outreach screening, health financing and coverage, supply of products, equipment, and drugs, infrastructure, improvement. The intervention could target any one of the five healthcare systems dimensions (approachability, acceptability, availability/accommodation, affordability, and appropriateness), or any of the population’s socioeconomic determinants resulting in the incorporation of the five corresponding abilities of individuals and populations: to perceive, to seek, to reach, to pay, and to engage, in healthcare included within the access conceptual framework. Context: Studies from the context would include: health and medical care and community care settings where immigrant populations receive cancer care. Type of sources We will include studies of primary or secondary data analyses. We will include systematic reviews or scoping reviews to retrieve their included studies that met our inclusion criteria. We will exclude commentaries, letters to the editor, protocols, and trial registrations. Strengths and limitations: This scoping review will have several strengths. First, this review will entail a rigorous search strategy developed by a professional librarian and conducted by multiple researchers having multidisciplinary backgrounds, enhancing its quality. Second, this review will not use language restrictions during the search strategy, thereby reducing the risk of publication bias and providing the opportunity to include studies from diverse cultures and contexts. Third, we have a multidisciplinary research team with extensive experience in carrying out systematic reviews (≥50), which ensures a quality process (minimizing potential biases) and will facilitate the completion and publication of this review within the scheduled timeframe. Fourth, one of the researchers also self-identifies as being culturally and ethnic diverse and belonging to a marginalized group. These features of our team will enrich the review analysis and findings. Finally, our review will not be limited to the scientific literature available in scientific databases; thus, we will be able to capture diverse primary and community health interventions as outlined in organisational documents publicly available in other sources. This review will also have limitations. First, there is always a possibility that some publications may not be identified by our search strategies (databases and grey literature). Second, while translating non-English articles using Google Translate will enable us to include them in the review, there is a risk of inaccuracies within translated material. Ethics and dissemination This scoping review does not require ethical approval since it will be based on publicly available documents. We will produce a scientific article for publication in a journal related to the field and share the published article results on social media platforms (e.g., LinkedIn). We will also share our findings through webinars, conferences and local events for lay and public audiences, researchers and health services administrators. Scoping review results will also be presented at workshops, research webinars and conferences organized by healthcare organizations or academic institutions. Finally, findings from this scoping review will set the base for developing empirical studies specifically addressing the knowledge gaps identified from our analysis.