Children described pain in ways that reflected cultural and spiritual frames. Some children quietly endured discomfort, preferring not to speak about suffering; investigators reported instances of religious or traditional coping used to interpret pain. Short, direct responses coexisted with richer, symbolic play narratives when children used sand-tray scenes or drawings to represent hospital experiences. The study team observed that spiritual frameworks sometimes provided meaning and coping resources, but the authors emphasized that such beliefs varied individually and were not assumed from Tibetan identity alone.
Language affected how pain was conveyed. Many children had limited Mandarin vocabulary for describing sensations, and investigators noted indirect verbal expressions of discomfort. Five interviews were entirely in Mandarin; ten involved Tibetan or mixed-language speech with a trained Tibetan–Mandarin interpreter. The interviewer and interpreter worked together to produce verified Mandarin transcripts within 24 hours, and the analysts used those transcripts as the primary data for coding. Data indicated that reliance on Mandarin self-report alone may under-detect pain when children resort to gestures, drawings, symbolic play, or nonverbal cues to communicate.
Family accompaniment emerged repeatedly as a central resource. Children reported emotional security when family members were present; relational continuity through parents or relatives provided calm during procedures and routine care. The study team recorded familiar, family-based comfort practices—simple routines and physical closeness—that children used to cope. Caregivers were present during interviews only for reassurance or linguistic clarification and were not treated as research participants; their statements were not coded or used in thematic analysis.
Hospital stays interrupted school and peer contact. Children described worries about falling behind in class and losing connections with friends. Investigators observed concerns about illness disclosure and potential social isolation, with some children fearful of how peers might react if they learned about the diagnosis. Play-based prompts elicited narratives about classroom absence and imagined peer responses, which researchers integrated with field notes to capture social disruption as an element of the pain experience.
The research used a descriptive phenomenological design guided by Husserlian principles, with bracketing and phenomenological reduction to remain close to participants’ accounts. Play-based, semi-structured interviews lasted roughly 15–45 minutes and employed drawing materials, toys, and sand-tray tools to facilitate child-centered expression. The interview guide included prompts about emotional responses, spiritual or traditional coping, Mandarin-language pain communication, and changes in school and peer relationships; prompts were used flexibly according to each child’s age and responsiveness.
Transcript preparation was iterative. For interviews containing Tibetan, a native Tibetan volunteer interpreter provided real-time interpretation and subsequently checked recordings against Mandarin transcripts. Two investigators independently read and coded the verified Mandarin transcripts, formulated meanings, and clustered themes; disagreements were resolved through discussion and, when needed, interpreter clarification. An adapted version of Colaizzi’s method was applied; the final descriptive structure was checked against transcripts and field notes. NVivo 12 supported data organization.
The authors acknowledged several concrete limitations. Participant validation—the final step of Colaizzi’s original method—was not completed because additional follow-up with young children receiving treatment was judged potentially burdensome. Analysis relied on Mandarin-language transcripts rather than primary coding in Tibetan; the interpreter assisted with verification but did not independently code. Caregivers were not interviewed and thus caregiver perspectives were not included in the analytic dataset. The study was conducted at a single pediatric hematology–oncology ward with a purposive sample of 15 children, which the authors recognized may limit transferability. De-identified data are not publicly available because transcripts contain potentially identifying information; the Ethics Committee of Sichuan Provincial People’s Hospital may consider requests for access on a case-by-case basis.
The findings reported by the study team point to practical assessment considerations: use child-centered communication, attend to indirect and nonverbal indicators, and incorporate family-based supports when assessing pain in Tibetan children with hematologic malignancies who receive care in predominantly Mandarin settings. The article ends with explicit methodological caveats and data-access procedures rather than broader speculative recommendations.