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Wegner LJ, Sarno EL, Whitton SW. Understanding the Association Between Medical Mistrust and Unmet Medical Care Need in Gender and Sexually Diverse People of Color Assigned Female at Birth. LGBT Health 2024. [PMID: 39149777 DOI: 10.1089/lgbt.2023.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Purpose: The present study investigated associations of sexual orientation and/or gender identity-based medical mistrust and racial/ethnic-based medical mistrust, respectively, with unmet medical care need among lesbian, gay, bisexual, transgender, queer, and/or sexually or gender diverse (LGBTQ+) people of color (POC) assigned female at birth (AFAB). We also tested the interaction of the two types of medical mistrust on unmet medical care need. Methods: Participants were 266 LGBTQ+ POC AFAB. Participants completed measures of medical mistrust based on race/ethnicity and LGBTQ+ identity. Unmet medical care need was assessed using the item: "During the past 12 months, was there ever a time where you felt that you needed health care but you didn't receive it?" Multivariate logistic regression models were run with either type of medical mistrust, as well as their interaction, as the predictor and unmet medical care need as the outcome variable. Results: There were no significant main effects of either type of medical mistrust on unmet medical care need. However, there was an interaction between the two types of medical mistrust, such that associations between each type of medical mistrust and unmet medical care needs were stronger at higher levels of the other type of medical mistrust. Racial/ethnic medical mistrust was associated with a greater likelihood of unmet medical needs at high, but not low, levels of LGBTQ+ medical mistrust. Conclusions: Racial/ethnic medical mistrust and LGBTQ+ medical mistrust exacerbate each other's influence on unmet medical care need. These results underscore the need for inclusive clinical practices for LGBTQ+ POC.
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Affiliation(s)
- Lindsay J Wegner
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elissa L Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
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Goodwill JR, Fike KJ. Black in the pandemic: Comparing experiences of mistrust, anxiety, and the COVID-19 vaccine among Black adults in the U.S. Soc Sci Med 2023; 338:116302. [PMID: 37871396 DOI: 10.1016/j.socscimed.2023.116302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
COVID-19 vaccine decisions are shaped by many factors including historical and contemporary patterns of medical mistreatment of marginalized communities. In attending to these concerns, we measured whether fear of COVID-19, general feelings of mistrust, and race-specific mistrust of the government and healthcare providers are indirectly associated with COVID-19 vaccination status via anxiety among Black Americans. We analyzed responses from 996 Black adults who participated in the AmeriSpeak panel - a nationally representative probability-based sample recruited from the National Opinion Research Center from April-June 2022. We used multiple-group structural equation modeling to compare outcomes among those who lost a loved one to COVID-19 to those who did not. Results indicate that fear of COVID-19 was associated with a greater probability of being fully vaccinated for those who lost a family member/friend. Race-specific mistrust was positively associated with anxiety, but was negatively associated with being fully vaccinated for bereaved Black Americans. Targeted efforts are needed to specifically reach those who lost a loved one to COVID-19. More within-group evaluations are needed to identify barriers to COVID-19 vaccination that are specific to Black Americans living with loss and grief.
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Affiliation(s)
- Janelle R Goodwill
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, United States.
| | - Kayla J Fike
- Vanderbilt University, Peabody College of Education and Human Development, United States
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Harms J, Kunzmann B, Bredereke J, Harms L, Jungbluth T, Zimmermann T. Anxiety in patients with gastrointestinal cancer undergoing primary surgery. J Cancer Res Clin Oncol 2023; 149:8191-8200. [PMID: 37060473 PMCID: PMC10374702 DOI: 10.1007/s00432-023-04759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Anxiety in the perioperative period is not only an unpleasant emotional state, but can also negatively affect the outcomes and quality of life of surgical patients. The present study investigated anxiety in patients with gastrointestinal cancer scheduled for primary surgery. METHODS A total of 101 patients in four non-university surgical departments were included. Anxiety (GAD-7), depression (PHQ-9), distress (Distress thermometer), and illness perception (Brief IPQ) were assessed at four time points: first outpatient contact before surgery (t1), preoperative inpatient contact (t2), postoperative inpatient contact before hospital discharge (t3), and postoperative outpatient follow-up contact after 30 days (t4). RESULTS 56% of patients had an episode of mild or moderate anxiety and 5% had an episode of severe anxiety and/or depression. Subjectively perceived anxiety and depression were highest at t1, followed by t3. 30% of patients had elevated anxiety and depression scores at t1. Regression analyses showed that high subjectively perceived mental distress at t1 was associated with higher anxiety scores at t3 and t4. Women, and younger women in particular, were significantly more likely to experience stress than men. Higher levels of subjectively perceived stress at t1 were associated with higher levels of anxiety at t3 and t4. Sociodemographic factors were not relevant predictors of anxiety. CONCLUSION Anxiety and depression appear to be a persistent problem during the perioperative course in patients with gastrointestinal tumors. Identifying patients at risk for clinically relevant anxiety and depression remains a particular challenge. The results confirm the relevance of repeated screening for mental distress.
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Affiliation(s)
- Jens Harms
- Department of Abdominal and Visceral Surgery, Klinikum Wolfsburg, Sauerbruchstrasse 7, 38140, Wolfsburg, Germany
| | - Benedikt Kunzmann
- Department of Abdominal and Visceral Surgery, Klinikum Wolfsburg, Sauerbruchstrasse 7, 38140, Wolfsburg, Germany
| | - Jan Bredereke
- Department of Psychosomatic Medicine and Psychotherapy, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lea Harms
- Department of Gynecology and Obstetrics, Columbia University of New York, New York, USA
| | - Thomas Jungbluth
- Department of Abdominal and Visceral Surgery, Klinikum Wolfsburg, Sauerbruchstrasse 7, 38140, Wolfsburg, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Abstract
Anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to anxiety in predominantly White samples are related to anxiety among Black individuals. Yet, given less mental health service utilization and greater experience of some life stressors, Black persons may be especially at risk for using false safety behaviors (FSB; designed to decrease anxiety in the short term, but are associated with more longer-term mental health problems). We tested whether non-Hispanic/Latin Black persons (n = 133) reported greater FSB use than non-Hispanic/Latin White participants (n = 844) as well as whether FSB use was related to more mental health problems among Black participants. Data were collected online among undergraduates. Black participants did endorse more frequent FSB use, especially FSB-Avoidance and FSB-Body Sensations. Results indicate that among Black participants, FSB use was related to more anxiety, depression, and suicidal thoughts and behaviors. FSB may be an important behavioral vulnerability factor related to anxiety and associated mental health problems among Black young adults.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Health Institute, University of Houston, Houston, TX, USA
| | - Mara L Ferrie
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Paige E Morris
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Ho IK, Sheldon TA, Botelho E. Medical mistrust among women with intersecting marginalized identities: a scoping review. ETHNICITY & HEALTH 2022; 27:1733-1751. [PMID: 34647832 DOI: 10.1080/13557858.2021.1990220] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this scoping review is to synthesize knowledge about medical mistrust and health among women who occupy other marginalized identities; namely women who also belong to one or more of the following social groups: people of color, people of low socioeconomic status, people with disabilities, lesbian and bisexual women, and/or women who have sex with women. This scoping review is based on the methodological framework by Arksey and O'Malley (2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8: 19-32. doi:10.1080/1364557032000119616). Specific search terms were entered into selected databases. Based on a set of inclusion criteria, articles were screened and assessed for eligibility. Data from the selected articles were extracted and summarized. Forty studies were included. Thirty-one studies used quantitative methodology, of which more than half used the Group-Based Medical Mistrust Scale. The majority of studies (84%) investigated the intersection of gender with race and ethnicity. Breast cancer and HIV combined accounted for more than half of the included studies. Of those studies that examined the relationship between medical mistrust and a health outcome or health behavior, almost all reported that medical mistrust had a deleterious impact. Medical mistrust among women with intersecting marginalized identities is worthy of further study, and there is still a dearth of knowledge in the role of medical mistrust among a wide range of subgroups of women and health domains.
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Affiliation(s)
- Ivy K Ho
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Taylor A Sheldon
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Elliott Botelho
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
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6
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Lake PW, Conley CC, Pal T, Sutton SK, Vadaparampil ST. Anxiety and depression among Black breast cancer survivors: Examining the role of patient-provider communication and cultural values. PATIENT EDUCATION AND COUNSELING 2022; 105:2391-2396. [PMID: 35440374 PMCID: PMC10777429 DOI: 10.1016/j.pec.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Breast cancer survivors frequently experience anxiety and depression post-treatment. Patient-provider communication and cultural values may impact these psychological outcomes. We examined the impact of patient-provider communication and cultural values on anxiety and depression among Black breast cancer survivors. METHODS Using an observational, cross-sectional design, 351 survivors self-reported patient-provider communication (quality, confidence), cultural values (religiosity, collectivism, future time orientation), anxiety, and depression. Patients were categorized into high, moderate, and low levels of communication and cultural values. Separate linear regressions examined the effect of levels of communication and cultural values on anxiety and depression, controlling for sociodemographic variables. RESULTS A subset of breast cancer survivors reported clinically significant symptoms of anxiety (40%) and depression (20%). Communication was associated with anxiety (β = -0.14, p = 0.01) and depression (β = -0.10, p = 0.04). Specifically, women reporting higher levels of communication quality/confidence reported lower levels of anxiety and depression. There was a trend towards a significant association between cultural values and depression (β = -0.09, p = 0.06). CONCLUSIONS Black breast cancer survivors experience poor psychological functioning. Effective patient-provider communication may reduce anxiety and depression post-treatment. PRACTICE IMPLICATIONS Patient-provider relationships and patient empowerment may be key components of cancer survivorship. Special attention should be paid to patient-centered communication for Black breast cancer survivors.
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Affiliation(s)
- Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL, USA
| | - Claire C Conley
- Georgetown University, Department of Oncology, Washington, DC, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA
| | - Steven K Sutton
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL, USA
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL, USA.
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7
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Vilardaga JCP, Fisher HM, Winger JG, Miller SN, Nuñez C, Majestic C, Kelleher SA, Somers TJ. Pain, depressive symptoms, and self-efficacy for pain management: examination in African-American women with breast cancer. Support Care Cancer 2022; 30:6633-6640. [PMID: 35501516 DOI: 10.1007/s00520-022-07083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE African-American women with breast cancer face significant disparities, including high levels of pain. Depressive symptoms and self-efficacy for pain management impact how women with breast cancer manage pain, yet little is known about how these variables relate to pain specifically for African-American women with breast cancer. METHODS Baseline linear regression analyses were conducted using a sample of women (n = 98) with stage I-III breast cancer identifying as Black or African-American who were part of a larger intervention trial. Linear regressions explored the effect of depressive symptoms on pain (i.e., severity and interference), and the effect of self-efficacy for pain management on pain. Covariates were age (M = 57.22, SD = 10.76), cancer stage (50% = stage 1), and education level (36% = some college). RESULTS Participants reported moderate levels of pain severity and interference. Higher depressive symptoms were related to both higher pain severity and interference; (B = 0.06, p < 0.01, 95% CI [0.02,0.09]) and (B = 0.13, p < 0.001, 95% CI [0.09, 0.17]) respectively. Likewise, lower self-efficacy for pain management was also related to both higher pain severity and interference; (B = - 0.04, p < 0.001, 95% CI [- 0.05, - 0.02]) and (B = - 0.06, p < 0.001, 95% CI [- 0.08, - 0.04]) respectively. Women reporting less than a high school diploma endorsed significantly higher pain severity and interference than women reporting some college. Age and cancer stage were not significantly related to pain. CONCLUSION Pain for African-American women with breast cancer may be influenced by depressive symptoms and self-efficacy for pain management, in addition to other important variables. Attending to better assessment and treatment of depressive symptoms and self-efficacy for pain management may improve outcomes.
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Affiliation(s)
- Jennifer C Plumb Vilardaga
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA.
| | - Hannah M Fisher
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Joseph G Winger
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Shannon N Miller
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Christine Nuñez
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Catherine Majestic
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Sarah A Kelleher
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
| | - Tamara J Somers
- Duke University Medical Center, Pain Prevention and Treatment Research Program, 2400, Pratt Street, 7th Floor, Durham, NC, 27705, USA
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Basinger ED, Hartsell H. Communal Coping and Self-Care in Black and White Individuals Living with Type 2 Diabetes. HEALTH COMMUNICATION 2021; 36:1961-1969. [PMID: 32844697 DOI: 10.1080/10410236.2020.1808408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Type 2 diabetes mellitus is both prevalent and profoundly impactful, and how people cope with the illness is related to a variety of individual and relational outcomes. The goal of this investigation was to test the logic of the recently extended Theoretical Model of Communal Coping (TMCC), a communication theory that argues that race (in this study, Black and White) moderates the relationship between communal coping and disease-related outcomes (i.e., glucose, diet, and exercise self-care). In general, survey data from 348 participants (n = 224 Black participants, n = 124 White participants) revealed that although communal coping was directly and positively related to self-care, the relationship between communal coping and self-care was stronger for Black participants than White participants. The results of the study have implications for the TMCC and for researchers, families managing type 2 diabetes, and healthcare practitioners.
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Affiliation(s)
- Erin D Basinger
- Department of Communication Studies, University of North Carolina at Charlotte
| | - Haley Hartsell
- Department of Communication Studies, University of North Carolina at Charlotte
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9
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Li Y, Liu H, Sun Y, Li J, Chen Y, Zhang X, Wang J, Wu L, Shao D, Cao F. Characteristics and subtypes of depressive symptoms in Chinese female breast cancer patients of different ages: a cross-sectional study. AIMS Public Health 2021; 8:691-703. [PMID: 34786429 PMCID: PMC8568601 DOI: 10.3934/publichealth.2021055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To identify the characteristics and subtypes of depressive symptoms and explore the relationship between depressive subtypes and age among Chinese female breast cancer patients. METHOD In this cross-sectional study, 566 breast cancer patients were recruited from three tertiary comprehensive hospital in Shandong Province, China through convenient sampling from April 2013 to June 2019. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Data analyses included descriptive analyses, latent class analysis. RESULTS There were significant differences in specific depressive symptoms by age group, but no significant difference in total scores on PHQ-9. The depressive subtypes were severe (Class 4), relatively severe (Class 3; with lower psychomotor agitation/retardation and suicidal ideation), moderate (Class 2; with higher psychomotor agitation/retardation and suicidal ideation), and mild depressive symptoms (Class 1). The distribution of depression subtypes is different in various age groups. In the 45-59 age groups, severe symptoms subtype showed the highest ratios (i.e. 50.3%). CONCLUSION This is the first study that analyses depressive symptom characteristics and identifies depressive subtypes in Chinese women with breast cancer across ages to explore symptom heterogeneity. Our findings can contribute to identifying the mechanisms behind these relationships and developing targeted interventions for patients with specific depressive subtypes.
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Affiliation(s)
- Yanyan Li
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| | - Hong Liu
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| | - Yaoyao Sun
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| | - Jie Li
- Center for Health Management and Policy Research, Shandong University, Shandong Province, China
| | - Yanhong Chen
- Department of Gastroenterology, Shandong Cancer Hospital and Institute, Shandong Province, China
| | - Xuan Zhang
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| | - Juan Wang
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| | - Liuliu Wu
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
| | - Di Shao
- Center for Health Management and Policy Research, Shandong University, Shandong Province, China
| | - Fenglin Cao
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong Province, China
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10
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Pre-diagnostic allostatic load and health-related quality of life in a cohort of Black breast cancer survivors. Breast Cancer Res Treat 2020; 184:901-914. [PMID: 32914357 DOI: 10.1007/s10549-020-05901-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the association of pre-diagnostic allostatic load (AL) with health-related quality of life (HRQOL) among Black women with breast cancer. METHODS In a sample of 409 Black women with non-metastatic breast cancer enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), two pre-diagnostic AL measures were estimated using medical records data from up to 12 months prior to breast cancer diagnosis: AL-lipid/metabolic profile-based measure and AL-inflammatory profile-based measure. HRQOL was assessed approximately 24 months post diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) instrument, including 5 subscale scores [presented by physical well-being (PWB), social & family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer-specific scale (BCS)] and 3 derived total scores [presented by trial outcome index (TOI), Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-B]. We used multivariable logistic regression models, using dichotomized AL scores (lower AL: 0-3 points, higher AL: 4-8 points), to assess the associations between the two pre-diagnostic AL measures and HRQOL. RESULTS Higher pre-diagnostic AL was associated with poorer FWB and lower FACT-G, but these associations were statistically significant for the AL-inflammatory profile-based measure (FWB: OR 1.63, 95% CI 1.04, 2.56; FACT-G: OR 1.62, 95% CI 1.04, 2.54), but not the AL-lipid/metabolic profile-based measure (FWB: OR 1.45, 95% CI 0.81, 2.59; FACT-G: OR 1.33, 95% CI 0.75, 2.37). CONCLUSION These findings suggest that higher AL, particularly when measured using the inflammatory profile-based measure, was associated with poorer HRQOL, namely FWB and FACT-G, among Black breast cancer survivors.
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Salsman JM, McLouth LE, Cohn M, Tooze JA, Sorkin M, Moskowitz JT. A Web-Based, Positive Emotion Skills Intervention for Enhancing Posttreatment Psychological Well-Being in Young Adult Cancer Survivors (EMPOWER): Protocol for a Single-Arm Feasibility Trial. JMIR Res Protoc 2020; 9:e17078. [PMID: 32463014 PMCID: PMC7290453 DOI: 10.2196/17078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/10/2020] [Accepted: 02/27/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations but have not been routinely tested in AYAs. OBJECTIVE The aim of this protocol is to (1) test the feasibility and acceptability of a Web-based positive emotion skills intervention for posttreatment AYAs called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) and (2) examine proof of concept for reducing psychological distress and enhancing psychological well-being. METHODS The intervention development and testing are taking place in 3 phases. In phase 1, we adapted the content of an existing, Web-based positive emotion intervention so that it would be suitable for AYAs. EMPOWER targets 8 skills (noticing positive events, capitalizing, gratitude, mindfulness, positive reappraisal, goal setting, personal strengths, and acts of kindness) and is delivered remotely as a 5-week, Web-based intervention. Phase 2 consisted of a pilot test of EMPOWER in a single-arm trial to evaluate feasibility, acceptability, retention, and adherence and to collect data on psychosocial outcomes for proof of concept. In phase 3, we are refining study procedures and conducting a second pilot test. RESULTS The project was part of a career development award. Pilot work began in June 2015, and data collection was completed in March 2019. The analysis is ongoing, and results will be submitted for publication by May 2020. CONCLUSIONS If this intervention proves feasible and acceptable, EMPOWER will be primed for a subsequent large, multisite randomized controlled trial. As a scalable intervention, it will be ideally suited for AYA survivors who would otherwise not have access to supportive care interventions to help manage posttreatment distress and enhance well-being. TRIAL REGISTRATION ClinicalTrials.gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17078.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Michael Cohn
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Mia Sorkin
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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12
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Parmelee Streck B, LoBiondo-Wood G. A systematic review of dyadic studies examining depression in couples facing breast cancer. J Psychosoc Oncol 2020; 38:463-480. [PMID: 32202229 DOI: 10.1080/07347332.2020.1734894] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Problem identification: The aim was to synthesize the dyadic literature on depression among couples in which one person has breast cancer.Literature search: A database search (PubMed, PsychInfo, CINAHL) was conducted to synthesize the literature. Studies' methodological quality was evaluated, and correlates of depression/interdependence were abstracted.Data evaluation/synthesis: Ten (of 270) studies met the inclusion criteria and were of satisfactory methodological quality. Depression is prevalent in both patients and partners, and was correlated with many psychosocial variables including sexual satisfaction, relationship quality, social support, and appraisal of health. Depression in one member of the dyad predicted depression in their companion.Conclusions: Levels of relationship quality, sexual satisfaction, and support felt by couples facing breast cancer may be predictive of depression in each individual. The depressive state of one partner appears to influence the other. More research is needed to support dyadic strategies for mitigating depression in couples facing breast cancer.
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Affiliation(s)
- Brennan Parmelee Streck
- University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, Texas, USA
| | - Geri LoBiondo-Wood
- University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, Texas, USA
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13
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Dye BA, Duran DG, Murray DM, Creswell JW, Richard P, Farhat T, Breen N, Engelgau MM. The Importance of Evaluating Health Disparities Research. Am J Public Health 2020; 109:S34-S40. [PMID: 30699014 DOI: 10.2105/ajph.2018.304808] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Health disparity populations are socially disadvantaged, and the multiple levels of discrimination they often experience mean that their characteristics and attributes differ from those of the mainstream. Programs and policies targeted at reducing health disparities or improving minority health must consider these differences. Despite the importance of evaluating health disparities research to produce high-quality data that can guide decision-making, it is not yet a customary practice. Although health disparities evaluations incorporate the same scientific methods as all evaluations, they have unique components such as population characteristics, sociocultural context, and the lack of health disparity common indicators and metrics that must be considered in every phase of the research. This article describes evaluation strategies grouped into 3 components: formative (needs assessments and process), design and methodology (multilevel designs used in real-world settings), and summative (outcomes, impacts, and cost). Each section will describe the standards for each component, discuss the unique health disparity aspects, and provide strategies from the National Institute on Minority Health and Health Disparities Metrics and Measures Visioning Workshop (April 2016) to advance the evaluation of health disparities research.
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Affiliation(s)
- Bruce A Dye
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - Deborah G Duran
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - David M Murray
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - John W Creswell
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - Patrick Richard
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - Tilda Farhat
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - Nancy Breen
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
| | - Michael M Engelgau
- Bruce A. Dye is with the National Institute of Dental and Craniofacial Research, National Institutes of Health (NIH), Bethesda, MD. Deborah G. Duran, Tilda Farhat, and Nancy Breen are with the National Institute on Minority Health and Health Disparities, NIH, Bethesda. David M. Murray is with the Office of the Director, Office of Disease Prevention, NIH, Bethesda. John W. Creswell is with the University of Michigan Medical School, Ann Arbor. Patrick Richard is with Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda. Michael M. Engelgau is with the National Heart, Lung, and Blood Institute, NIH, Bethesda. Tilda Farhat and Nancy Breen are also Guest Editors for this supplement issue
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Truong DV, Bui QTT, Nguyen DT, Moore J. Anxiety Among Inpatients With Cancer: Findings From a Hospital-Based Cross-Sectional Study in Vietnam. Cancer Control 2020; 26:1073274819864641. [PMID: 31327239 PMCID: PMC6647225 DOI: 10.1177/1073274819864641] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Anxiety, a condition which is commonly found in patients with cancer, has negative impacts on their quality of life and treatment outcome. This study aimed to determine the level of anxiety in patients with cancer and explore sociodemographic, disease-related, and hospital-related factors associated with anxiety in those patients. A cross-sectional study was conducted on 510 inpatients with cancer at Thanh Hoa Oncology Hospital, Vietnam. Data were collected from self-administered questionnaire forms on hospital depression anxiety-A, interviews with patients, and patient medical records. The univariate and multivariate linear regression analyses were performed using STATA ver. 14.0. Our finding that the patients' mean anxiety score (standard deviation) was 7.22 (3.8); 27.6% of the patients had an anxiety score between 8 and 10 points, and 15.5% had an anxiety score of ≥11 points. In the multivariate model, in more advanced stages of cancer, and patients with metastasis were more likely to have higher levels of anxiety than those who presented no sign of metastasis. The longer the patients had cancer, the less anxious they became. Lower levels of anxiety were observed in patients who stated that hospital facilities were adequate or had trust in health workers. Patients with cancer need to be provided with psychological support in the early stage of cancer detection and when metastases form. A strong patient-health-care provider relationship after diagnosis may help reduce distress among patients with cancer with higher levels of medical mistrust.
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Affiliation(s)
- Dung Viet Truong
- 1 Faculty of Health Sciences, Thang Long University, Ha Noi, Vietnam
| | - Quyen Thi Tu Bui
- 2 Biostatistics Department, Hanoi University of Public Health, Ha Noi, Vietnam
| | - Do Tri Nguyen
- 3 Department of Science and Technology, Thanh Hoa Oncology Hospital, Thanh Hoa, Vietnam
| | - Jaleesa Moore
- 4 Molecular and Genetic Epidemiology of Cancer, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Johnson VE, Carter RT. Black Cultural Strengths and Psychosocial Well-Being: An Empirical Analysis With Black American Adults. JOURNAL OF BLACK PSYCHOLOGY 2019. [DOI: 10.1177/0095798419889752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Based on historical literature, Black Americans have persisted through centuries of oppression in North America. To survive, they retained Africultural values and adopted group-specific practices. Black cultural values and practices can potentially, if bolstered, increase psychosocial health in this population. In the current study, we examined specific Black values and practices and their collective ability to predict psychosocial health. In a sample 486 Black, middle-class, American adults with a mean age of 31 years, we used structural equation modeling to test a first- and a second-order measurement model, as well as a structural model. We hypothesized that health-promoting aspects of Black racial identity (e.g., racial centrality), racial socialization (e.g., cultural socialization), and racism-related coping (e.g., confrontation), as well as higher levels of communalism and spirituality would indicate one latent factor, Black Cultural Strength. Furthermore, we hypothesized that Black Cultural Strength would be predictive of psychosocial health. After slight model modifications, we found an acceptable fit for the data. Clinical implications and future research directions are discussed.
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Perry LM, Hoerger M, Sartor O, Robinson WR. Distress among African American and White adults with cancer in Louisiana. J Psychosoc Oncol 2019; 38:63-72. [PMID: 31322062 DOI: 10.1080/07347332.2019.1634176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose/Objectives: Screening for distress is a key priority in cancer care, and African American patients may experience increased distress compared to White patients. However, this question has not yet been addressed in Louisiana. The purpose of the present study was to examine the relationship between African American race and distress at a cancer center in Louisiana.Design/Methods: This was a retrospective study of 1,544 patients who were treated at an academic cancer center in 2015. Extracted data included patient self-reports of distress using the single-item Distress Thermometer (DT) and demographic and clinical characteristics. Hypotheses were tested using logistic regression.Findings: Distress was present in 19.7% of the sample. In univariate analyses, African American patients were more likely than White patients to experience distress (OR = 1.38, p = .013). However, race was no longer associated with distress in a multivariate analysis that adjusted for the covariates of age, gender, cancer site, presence of metastases, and number of distress screenings (OR = 1.07, p = .670). Distress was more common in patients who were younger (OR = 2.26, p < .001), diagnosed with lung/bronchus cancer (OR = 5.28, p < .001), or screened more often (OR = 5.20, p < .001). Distress was less common among patients with female breast cancer (OR = 0.39, p = .015).Conclusions/Implications: This study suggests that African American individuals with cancer in Louisiana are at increased risk for distress, but that this can be attributed to African American patients being younger, more likely to have lung cancer, and screened more frequently. Implications include careful consideration of patient race, age, and cancer site during distress management in cancer care.
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Affiliation(s)
- Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Oliver Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William R Robinson
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
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17
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Sutton AL, He J, Edmonds MC, Sheppard VB. Medical Mistrust in Black Breast Cancer Patients: Acknowledging the Roles of the Trustor and the Trustee. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:600-607. [PMID: 29552705 PMCID: PMC7061268 DOI: 10.1007/s13187-018-1347-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies indicate that Black patients report higher medical mistrust compared to their White counterparts. However, little is known about factors associated with higher medical mistrust among Black breast cancer patients. We examined predictors of medical mistrust and relationships between medical mistrust, subscales of mistrust, and process of care factors to identify opportunities to promote positive healthcare interactions between the trustees (e.g., providers) and Black breast cancer patients, or the trustors. A secondary analysis was conducted of survey data from 210 Black women with confirmed diagnosis of invasive breast cancer. Participants completed telephone surveys consisting of questions pertaining to sociodemographics, attitudes, and beliefs about medical care and breast cancer treatments. Multiple linear regression determined factors associated with medical mistrust and mistrust subscales. Most participants (61%) were over the age of 50 and currently single (64.8%). Women with greater medical mistrust reported less satisfaction with the trustee's technical ability (p < 0.0001) and greater satisfaction with their own propensity to access care (p < 0.05). Additionally, women with public insurance demonstrated greater mistrust (p < 0.01) and suspicion (p < 0.05) than women with private insurance, and women with less education reported greater perceived discrimination than women who have at least a bachelor's degree. Findings from this study may inform future endeavors to educate providers on ways to effectively interact with and treat Black breast cancer patients. Opportunities to develop interventions that address and tackle issues of mistrust as reported by Black patients may contribute to ongoing efforts to reduce health disparities.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA.
| | - Jun He
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Megan C Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
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An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors. Cancer Nurs 2018; 41:139-155. [DOI: 10.1097/ncc.0000000000000477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Watkins CC, Kamara Kanu I, Hamilton JB, Kozachik SL, Gaston-Johansson F. Differences in Coping Among African American Women With Breast Cancer and Triple-Negative Breast Cancer. Oncol Nurs Forum 2017; 44:689-702. [PMID: 29052667 DOI: 10.1188/17.onf.689-702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine differences in psychological distress, symptoms, coping capacity, and coping abilities among African American (AA) women with triple-negative breast cancer (TNBC) and non-TNBC and to explore differences in relationships among these variables.
. DESIGN A prospective, descriptive, comparative, and correlational design.
. SETTING Johns Hopkins Hospital in Baltimore, Maryland.
. SAMPLE 30 AA women with breast cancer.
. METHODS Patients completed questionnaires during chemotherapy. The Transactional Model of Stress and Coping was used to guide the research.
. MAIN RESEARCH VARIABLES Psychological distress, symptoms, coping capacity, and coping ability.
. FINDINGS Patients with non-TNBC reported more intense present total pain, nausea and vomiting, better emotional functioning, lower cognitive functioning, use of significantly more prayer and hope, and more coping self-statements. A lower coping capacity score was associated with psychological distress in the TNBC group at midpoint and in both groups at completion of chemotherapy treatment. Patients in both groups used a higher level of positive religious coping.
. CONCLUSIONS AA women with TNBC and non-TNBC might benefit (reduced psychological distress and improved coping skills) from receiving a comprehensive psychological care program. The findings can be incorporated and tested in a comprehensive coping strategy program.
. IMPLICATIONS FOR NURSING Nurses should work closely with AA women with breast cancer undergoing chemotherapy to help them identify and consciously use coping strategies associated with increased coping capacity.
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Dean LT, Moss SL, McCarthy AM, Armstrong K. Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations. Cancer Epidemiol Biomarkers Prev 2017; 26:1745-1752. [PMID: 28971987 DOI: 10.1158/1055-9965.epi-17-0479] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust.Methods: Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust.Results: Of the 2,754 participants, 30.2% (n = 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance.Conclusions: Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer.Impact: Interventions should test whether or not resolving institutional distrust reduces treatment discordance. Cancer Epidemiol Biomarkers Prev; 26(12); 1745-52. ©2017 AACR.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. .,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Anne Marie McCarthy
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katrina Armstrong
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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21
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Tejeda S, Stolley MR, Vijayasiri G, Campbell RT, Estwing Ferrans C, Warnecke RB, Rauscher GH. Negative psychological consequences of breast cancer among recently diagnosed ethnically diverse women. Psychooncology 2017; 26:2245-2252. [PMID: 28499328 DOI: 10.1002/pon.4456] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/23/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Breast cancer has psychological consequences that impact quality of life. We examined factors associated with negative psychological consequences of a breast cancer diagnosis, in a diverse sample of 910 recently diagnosed patients (378 African American, 372 white, and 160 Latina). METHODS Patients completed an in-person interview as part of the Breast Cancer Care in Chicago study within an average of 4 months from diagnosis. The Cockburn negative psychological consequences of breast cancer screening scale was revised to focus on a breast cancer diagnosis. Path analysis assessed predictors of psychological consequences and potential mediators between race/ethnicity and psychological consequences. RESULTS Compared to white counterparts, bivariate analysis showed African American (β = 1.4, P < .05) and Latina (β = 3.6, P < .001) women reported greater psychological consequences. Strongest predictors (P < .05 for all) included unmet social support (β = .38), and provider trust (β = .12), followed by stage at diagnosis (β = .10) and perceived neighborhood social disorder (β = .09).The strongest mediator between race/ethnicity and psychological consequences was unmet social support. CONCLUSIONS African American and Latina women reported greater psychological consequences related to their breast cancer diagnosis; this disparity was mediated by differences in unmet social support. Social support represents a promising point of intervention.
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Affiliation(s)
- Silvia Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Melinda R Stolley
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ganga Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Richard T Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Carol Estwing Ferrans
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Richard B Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Garth H Rauscher
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago (UIC), Chicago, IL, USA
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22
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Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ. High Levels of Medical Mistrust Are Associated With Low Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control 2017; 24:72-77. [PMID: 28178717 DOI: 10.1177/107327481702400112] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with prostate cancer. METHODS A total of 877 men (415 black, 462 white) with prostate cancer between the ages of 40 to 81 years who entered the North Carolina Central Cancer Registry during the years 2007 and 2008 were retrospectively recruited. The dependent variable was overall QOL measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The primary independent variable was medical mistrust. Multivariate regression analysis was used to assess the association between medical mistrust and overall QOL. RESULTS Compared with white men, black men reported a higher level of medical mistrust (black = 2.7, white = 2.4; P < .001) and lower QOL (black = 134.4, white = 139.5; P < 0.001). After controlling for demographical and clinical variables, higher levels of medical mistrust were associated with a reduction in overall QOL among men with prostate cancer (beta = -7.73; standard error = 1.54) CONCLUSIONS: Higher levels of medical mistrust are associated with reduced overall QOL among black and white men with prostate cancer. Interventions targeted to reduce medical mistrust may be effective in increasing the overall QOL of men with prostate cancer.
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Affiliation(s)
- Ballington L Kinlock
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Lauren J Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Janice V Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel L Howard
- Public Policy Research Institute and Department of Sociology, Texas A&M University, College Station, TX
| | - Thomas A LaVeist
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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23
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Lang MJ, David V, Giese-Davis J. The Age Conundrum: A Scoping Review of Younger Age or Adolescent and Young Adult as a Risk Factor for Clinical Distress, Depression, or Anxiety in Cancer. J Adolesc Young Adult Oncol 2016; 4:157-73. [PMID: 26697266 DOI: 10.1089/jayao.2015.0005] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This scoping review was conducted to understand the extent, range, and nature of current research on adolescents and young adults (AYA) with cancer and distress, depression, and anxiety (DDA). This information is necessary to find and aggregate valuable data on the AYA population embedded in generalized studies of DDA. Keyword searches of six relevant electronic databases identified 2156 articles, with 316 selected for abstract review and 40 for full text review. Full-text reviews and data extraction resulted in 34 studies being included, which ranged widely in design, sample size, age-range categorization, analysis methods, DDA measurement tool, overall study rigor, and quality of evidence. Studies very seldom reported using theory to guide their age categorization, with only four studies giving any rationale for their age-group definitions. All 34 studies found a significant association between at least one DDA construct and the younger age group relative to the older age groups at some point along the cancer trajectory. However, age as an independent risk factor for DDA is still unclear, as the relationship could be confounded by other age-related factors. Despite the wide range of definitions and effect sizes in the studies included in this review, one thing is clear: adolescents and young adults, however defined, are a distinct group within the cancer population with an elevated risk of DDA. Widespread adoption of a standard AYA age-range definition will be essential to any future meta-analytical psycho-oncology research in this population.
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Affiliation(s)
- Michael J Lang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Alberta, Canada . ; Provincial Integrated Survivorship Program, Provincial Practices, Alberta Health Services-Cancer Control , Alberta, Canada
| | - Victoria David
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary , Alberta, Canada
| | - Janine Giese-Davis
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Alberta, Canada . ; Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Control , Alberta, Canada . ; Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary , Alberta, Canada
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24
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Barsevick AM, Leader A, Bradley PK, Avery T, Dean LT, DiCarlo M, Hegarty SE. Post-treatment problems of African American breast cancer survivors. Support Care Cancer 2016; 24:4979-4986. [PMID: 27543161 DOI: 10.1007/s00520-016-3359-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79 %) compared with White survivors (92 %) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5 years after treatment completion and identifies subgroups at risk for these problems. METHODS A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18 years of age who completed primary treatment for breast cancer in the past 5 years. A mailed survey was used to document survivorship problems. RESULTS Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems. CONCLUSIONS The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.
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Affiliation(s)
- Andrea M Barsevick
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Amy Leader
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | | | | | - Melissa DiCarlo
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Sarah E Hegarty
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
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Prevalence and predictors of distress in women taking part in surgical continuity of care for breast cancer: A cohort study. Eur J Oncol Nurs 2016; 22:30-6. [DOI: 10.1016/j.ejon.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 01/16/2023]
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Gold M, Dunn LB, Phoenix B, Paul SM, Hamolsky D, Levine JD, Miaskowski C. Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life. Eur J Oncol Nurs 2016; 20:97-105. [PMID: 26187660 PMCID: PMC4706814 DOI: 10.1016/j.ejon.2015.06.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Little is known about the prevalence of combined anxiety and depressive symptoms (CADS) in breast cancer patients. Purpose was to evaluate for differences in demographic and clinical characteristics and quality of life (QOL) prior to breast cancer surgery among women classified into one of four distinct anxiety and/or depressive symptom groups. METHODS A total of 335 patients completed measures of anxiety and depressive symptoms and QOL prior to and for 6 months following breast cancer surgery. Growth Mixture Modelling (GMM) was used to identify subgroups of women with distinct trajectories of anxiety and depressive symptoms. These results were used to create four distinct anxiety and/or depressive symptom groups. Differences in demographic, clinical, and symptom characteristics, among these groups were evaluated using analyses of variance and Chi square analyses. RESULTS A total of 44.5% of patients were categorized with CADS. Women with CADS were younger, non-white, had lower performance status, received neoadjuvant or adjuvant chemotherapy, had greater difficulty dealing with their disease and treatment, and reported less support from others to meet their needs. These women had lower physical, psychological, social well-being, and total QOL scores. Higher levels of anxiety with or without subsyndromal depressive symptoms were associated with increased fears of recurrence, hopelessness, uncertainty, loss of control, and a decrease in life satisfaction. CONCLUSIONS Findings suggest that CADS occurs in a high percentage of women following breast cancer surgery and results in a poorer QOL. Assessments of anxiety and depressive symptoms are warranted prior to surgery for breast cancer.
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Affiliation(s)
- Marshall Gold
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Bethany Phoenix
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Deborah Hamolsky
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, CA, USA
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Mariano C, Hanson LC, Deal AM, Yang H, Bensen J, Hendrix L, Muss HB. Healthcare satisfaction in older and younger patients with cancer. J Geriatr Oncol 2016; 7:32-8. [PMID: 26774226 DOI: 10.1016/j.jgo.2015.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/12/2015] [Accepted: 11/30/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Although older patients represent the most rapidly growing segment of the oncology population, clinical care is guided by very little data on patient-reported outcomes, particularly satisfaction with healthcare. Using a large cancer center registry, we sought to describe factors associated with satisfaction with care for older and younger oncology patients. METHODS Data were collected through the University of North Carolina Health Registry Cancer Survivorship Cohort. Satisfaction was measured with the Patient Satisfaction Questionnaire Short Form. Quality of life (QOL) measures included were the Promis Global short form and the Functional Assessment of Cancer Therapy General (FACT-G). RESULTS A total of 2385 patients were included. 460 (20%) were aged 70 and above (older group). Older patients reported significantly higher levels of satisfaction in domains of time spent with doctor (scores 3.84 versus 3.73 p=0.03) and financial aspects (scores 4.03 versus 3.44 p<0.001) compared to younger patients. In multivariable analysis, higher QOL scores and higher self-reported ECOG performance status were associated with higher satisfaction scores. African American race was associated with lower satisfaction scores in all age groups. QOL was more closely correlated with satisfaction in older patients compared to younger patients. CONCLUSIONS Older patients with cancer report higher levels of satisfaction with care, in part due to lesser financial burden of care. Better QOL is associated with satisfaction with care in older patients. Use of patient-reported outcomes such as patient satisfaction may help improve patient-centered geriatric oncology care.
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Affiliation(s)
- Caroline Mariano
- Royal Columbian Hospital, Medical Oncology, University of British Columbia, New Westminster, BC, Canada.
| | - Laura C Hanson
- Division of Geriatric Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, Biostatistics Core, University of North Carolina, Chapel Hill, NC, USA
| | - Hojin Yang
- Lineberger Comprehensive Cancer Center, Biostatistics Core, University of North Carolina, Chapel Hill, NC, USA
| | - Jeannette Bensen
- Lineberger Comprehensive Cancer Center, Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Laura Hendrix
- Lineberger Comprehensive Cancer Center, Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Hyman B Muss
- Medicine/Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jørgensen L, Garne J, Søgaard M, Laursen B. The experience of distress in relation to surgical treatment and care for breast cancer: An interview study. Eur J Oncol Nurs 2015; 19:612-8. [DOI: 10.1016/j.ejon.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Molina Y, Kim S, Berrios N, Calhoun EA. Medical mistrust and patient satisfaction with mammography: the mediating effects of perceived self-efficacy among navigated African American women. Health Expect 2015; 18:2941-50. [PMID: 25308749 PMCID: PMC4393336 DOI: 10.1111/hex.12278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medical mistrust is salient among African American women, given historic and contemporary racism within medical settings. Mistrust may influence satisfaction among navigated women by affecting women's perceptions of their health-care self-efficacy and their providers' roles in follow-up of abnormal test results. OBJECTIVES To (i) examine whether general medical mistrust and health-care self-efficacy predict satisfaction with mammography services and (ii) test the mediating effects of health-related self-efficacy. DESIGN The current study is a part of a randomized controlled patient navigation trial for medically underserved women who had received a physician referral to obtain a mammogram in three community hospitals in Chicago, IL. After consent, 671 African American women with no history of cancer completed questionnaires concerning medical mistrust and received navigation services. After their mammography appointment, women completed health-care self-efficacy and patient satisfaction questionnaires. RESULTS Women with lower medical mistrust and greater perceived self-efficacy reported greater satisfaction with care. Medical mistrust was directly and indirectly related to patient satisfaction through self-efficacy. CONCLUSIONS Preliminary findings suggest future programmes designed to increase health-care self-efficacy may improve patient satisfaction among African American women with high levels of medical mistrust. Our findings add to a growing body of literature indicating the importance of self-efficacy and active participation in health care, especially among the underserved.
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Affiliation(s)
- Yamile Molina
- School of Public HealthUniversity of WashingtonSeattleWAUSA
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
| | - Sage Kim
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
| | - Nerida Berrios
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
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Contextual factors influencing health-related quality of life in African American and Latina breast cancer survivors. J Cancer Surviv 2015; 9:441-9. [PMID: 25576214 DOI: 10.1007/s11764-014-0420-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/06/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE This study explored the relationships between systemic- and individual-level contextual factors and health-related quality of life (HRQOL) in a cohort of African American and Latina breast cancer survivors (BCS). METHODS Baseline questionnaire data of 320 BCS who participated in a HRQOL psycho-educational intervention were abstracted from the parent study. Hierarchical regression analysis tested the independent effects of contextual factors on HRQOL. RESULTS HRQOL was higher in BCS who: were diagnosed at < stage 2 (b = -1.38, p < 0.05), expressed satisfaction with their health care (b = 0.20, p < 0.001), had fewer comorbidities (b = - 0.60, p < 0.001) and depressive symptoms (b = -0.30, p < 0.001), and practiced healthy diet and exercise habits (b = 0.02, p < 0.05). Demographic and cancer-related factors accounted for 14 % of the variance in HRQOL (F[6, 274] = 7.25, p < 0.001). The socio-cultural context (i.e., ethnicity, life stress, perceived social support) explained 20 % of the variance in HRQOL (FΔ[3, 271] = 27.32, p < 0.001). The health care system context contributed an additional 8 % to explaining HRQOL (FΔ[1, 270] = 34.88, p < 0.001). Health status and behavioral factors accounted for 18 % of the variance (FΔ[4, 266] = 29.55, p < 0.001). The full model explained 59 % of the variance in HRQOL (F[14, 266] = 27.76, p < 0.001). CONCLUSIONS HRQOL in ethnic minority BCS is multifaceted and is significantly influenced by cancer-related, socio-cultural, health care system, health status, and behavioral contextual factors. Therefore, survivorship research and practice must address broad multi-level domains to achieve equitable and optimal breast cancer outcomes. IMPLICATIONS FOR CANCER SURVIVORS To enhance HRQOL, survivors must be provided the know-how and support to maintain healthy lifestyle and self-management practices. Advocates must engage the care team to consider systemic factors, including life stress and community resources, to be more patient-centered.
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Sheppard VB, Llanos AA, Hurtado-de-Mendoza A, Taylor TR, Adams-Campbell LL. Correlates of depressive symptomatology in African-American breast cancer patients. J Cancer Surviv 2013; 7:292-9. [PMID: 23471730 DOI: 10.1007/s11764-013-0273-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/18/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE This study assessed the levels of depressive symptomatology in African-American women with breast cancer compared to those of women without breast cancer and examined demographic, psychosocial, and clinical factors correlated with depression. METHODS A total of 152 African-American women were recruited from Washington, DC and surrounding suburbs. Breast cancer patients (n = 76 cases) were recruited from a health care center and women without cancer were recruited from health fairs (n = 76 comparison). We assessed depression, psychosocial variables (ego strength and social support), and sociodemographic factors from in-person interviews. Stage and clinical factors were abstracted from medical records. Independent sample t test, chi square test, analyses of variance, and multiple regression models were used to identify differences in depression and correlates of depression among the cases and comparison groups. RESULTS Women with breast cancer reported significantly greater levels of depression (m = 11.5, SD = 5.0) than women without breast cancer (m = 3.9, SD = 3.8) (p < 0.001). Higher cancer stage (beta = 0.91) and higher age (beta = 0.11) were associated with depression in the breast patients, explaining 84 % of the variance. In the comparison group, ego strength and tangible support were inversely associated with depressive symptoms, accounting for 32 % of the variance. CONCLUSIONS Women with more advanced disease may require interdisciplinary approaches to cancer care (i.e., caring for the whole person). IMPLICATIONS FOR CANCER SURVIVORS Depression is often underrecognized and undertreated in African-American breast cancer patients. Understanding the factors related to depression is necessary to integrate psychosocial needs to routine cancer care to improve survivors' quality of life.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Oncology, Lombardi Comprehensive Cancer Center, 3300 Whitehaven St. NW, Washington, DC 20007, USA.
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