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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Rachel K. Walker

Second Advisor

Cynthia Jacelon

Third Advisor

Susan Hankinson

Subject Categories

Geriatric Nursing | Other Nursing


The author conducted this constructivist grounded theory study to describe perceptions, behaviors, and communication that hospice caring triads engage in while managing cancer pain, specifically how these social processes can be assessed and used to improve poorly-controlled pain.

Three hospice caring triads comprised of patients, family caregivers, and nurses along with one nurse-patient dyad, were recruited into this longitudinal qualitative study. Each group was observed during nursing visits. Triad and dyad members were individually interviewed. Nurses participated in a focus group and survey. The author used constant comparative methods of data analysis, including line-by-line gerund coding, theoretical codes from cancer pain assessment standards, theoretical sampling of early codes, memo writing, and concept-mapping to raise codes into concepts and domains for a theoretical framework. Study trustworthiness included appropriate methodology to answer research questions, prolonged and repeated participant engagement, triangulation of content across participants, reflexive memos, and use of multiple data sources.

Results were presented in a triadic case study comparing and contrasting the two cancer pain social processes domains related to pain control: Controlling Cancer Pain and Proximity. The first domain included perceptions of pain control, goals, and efficacy. The second domain included physical and emotional distance between triad members, presence of communication, and level of agreement. When triads were compared, one triad with close emotional and physical proximity had a shared perception of pain meaning and goals for control, and effective communication for pain management behaviors. The other triads had more physical and emotional distance, communication that was vague, and differing perceptions of pain control, pain meaning, or control goals. An important difference for these other triads was a lack of agreement about pain perception and pain severity, as well as vague communication about pain perception, with subsequent impact on pain goals.

Controlling Cancer Pain and Proximity social processes are inextricable with cancer pain management for hospice caring triads. Assessment tools for proximity-related social processes which measure closeness, communication, and agreement among hospice caring triad members should be developed and tested for improving cases of poorly controlled pain. Development and testing of simple open-ended functional goal assessments is needed.