Self-Reliance in a Fractured Health Care System: A Qualitative Study of Rural Oklahoman’s Experiences Managing Cancer Pain During the Opioid Epidemic

Objectives: Rural-dwelling adults with advanced cancer and pain face obstacles to achieving cancer pain management. We explored patients’ experiences managing cancer pain while living in rural Oklahoma to improve access and overcome barriers to current treatments. Methods: We recruited patients from Oklahoma’s only National-Cancer Institute (NCI)-designated cancer center. We included those aged ≥21 years with an incurable solid or hematological malignancy residing in rural Oklahoma (Rural–Urban Commuting Area code ≥4). Interview topics included pain self-management practices, health care utilization, and descriptions of participants’ daily lives. We transcribed interviews verbatim and used an inductive, critical realist approach to reflexive thematic analysis. Results: Among 11 participants (mean [SD] = 62 [11] y /o), most were male (73%) and identified as White (64%), with 27% identifying as American Indian. Most (73%) had an annual income ≤$40,000. Participants’ cancer pain management experiences were shaped by the rural context through structural (distance, costs), interpersonal, and intrapersonal barriers. Participants compared greater familiarity within rural care settings with disconnection within the urban cancer center. In the context of the opioid epidemic, barriers to opioids contributed to hopelessness for some participants because within their cancer pain management plans, opioids were often the sole treatment option. Most exhibited stoicism and self-reliance while also utilizing community support, eventually connecting with urban cancer services and experiencing pain relief. Conclusions: Structural, cultural, and intrapersonal obstacles coexisted with hopelessness and disconnection from oncology/pain care clinicians. These experiences influenced how rural-dwelling adults with advanced cancer pain engaged with health care, self-managed, and coped with pain. Our findings highlight the importance of multimodal pain care grounded within the local cultural context.