Translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil) to evaluate patients with head and neck cancer

Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study

PURPOSE

Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC.

METHODS

This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson's product-moment correlation, and multiple regression.

RESULTS

The two top-ranked subscales of shame and stigma were: "speech and social concerns" and "regret". Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma.

CONCLUSION

Patients' body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

Assessment of Shame and Stigma in Head and Neck Cancer: A Meta-Analysis

Background

Head and neck cancer is the most common cancer around the globe, following lung cancer and breast cancer. Treatment at advanced stages of head and neck cancer is usually followed intense surgical procedures, which leads to mutilation among patients. Mutilation imparts a sense of disgrace and causes a feeling of shame and stigma in the patient. The feeling of shame and stigma persists over time and affects the overall long-term survival of patients by deteriorating their quality of life.

Objectives

Since shame and stigma is an important psychological domain of head and neck cancer, the present article aims toward evaluating the studies published so far for the assessment of shame and stigma in head and neck cancer and highlighting the lacunae in the existing research designs. The present study also aims to design a checklist that could be followed while developing, translating, or validating a psychometric instrument that aims to measure shame and stigma in head and neck cancer.

Methods

In the present metanalysis, all articles published in the past years on shame and stigma in head and neck cancer was compiled using a predefined data extraction matrix. The available literature was compiled for major objectives of the study, the sample size used, major findings, and critical lacunae that need to be addressed.

Results

Shame and stigma is a very important domain of psychological well-being in head and neck cancer patients, which yet not appropriately addressed and further need to be researched.

Conclusion

Future studies could be based on the lacunae highlighted in the existing literature, and the prescribed methodology checklist could be taken into consideration while conducting further studies involving developing, translating, or validating a psychometric instrument related to shame and stigma in the head and neck cancer.

Development and validation of the thyroid cancer self-perceived discrimination scale to identify patients at high risk for psychological problems

Objective

To develop a Thyroid Cancer Self-Perceived Discrimination Scale (TCSPDS) to identify patients at high risk for psychological problems and to test its reliability, validity and acceptability.

Methods

Using classical test theory, a total of 176 thyroid cancer patients from November 2021 to October 2022 were recruited to develop the TCSPDS. Item analysis was used to improve the preliminary TCSPDS. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation model (SEM) were used to test the construct validity of the final TCSPDS. Pearson correlation coefficient was used to analyze the validity coefficient between TCSPDS and EORTC QLQ-C30 to test the criterion-related validity (CRV) of the final TCSPDS. The internal consistency coefficient (Cronbach's alpha coefficient), split half reliability (Spearman-Brown coefficient) and test-retest reliability were used to verify the reliability of the final TCSPDS. The questionnaire completion time and effective response rate were used to validate the acceptability of the final TCSPDS.

Results

The TCSPDS consisted of 20 items and was divided into 3 subscales: 8 items for stigma, 6 items for self-deprecation, and 6 items for social avoidance. The TCSPDS had good validity (χ2/df=1.971, RMSEA=0.074, GFI=0.921, CFI= 0.930, IFI=0.932, TLI=0.901, Validity coefficient=0.767), reliability (Cronbach's alpha=0.867, Spearman-Brown coefficient=0.828, test-retest reliability coefficient=0.981) and acceptability [average completion time (15.01 ± 1.348 minutes) and an effective response rate of 95.14%]. Patients with higher TCSPDS scores reported a lower quality of life (P<0.05).

Conclusion

The TCSPDS could be used for early identification and assessment of the level of self-perceived discrimination in patients with thyroid cancer, which may provide a scientific basis for health education, social support and psychosocial oncology services in the future, especially in Southwest China.

Accuracy of a self-reported Measure in Psychological Assessment when the Instrument is self-administered by the Patient or when Administrated by the Clinician

Background

Self-reported measures are the questionnaire-based instrument that are routinely used in the clinical scenario to assess psychological health. Technically, the self-reported measure should be administrated by the patients themselves but due to the complexity of tools and illiteracy among patients, clinicians often tend to interview the patients.

Objective

Present article aims to compare the accuracy of a self-reported measure in the assessment of the psychological health of a patient when the instrument is self-administrated by the patient and when administrated by the clinician or researcher.

Methods

We have recruited 43 patients of oral cancer in the study who have a tumor in the buccal mucosa region. The Hindi version of the shame and stigma scale was used to analyse the shame and stigma in patients. The questionnaire was first provided to the patient for the self-administration and after that clinician administrated the questionnaire to the patient by keeping the clinician blinded to the patient self-administrated responses.

Results

There was no significant difference in the global mean score and mean score of various subdomains of shame and stigma scale in the self-administered and clinician-administered mode of interview. However, the clinician-administered mode could provide more accurate measures as it helps the patient towards a better understanding of questions.

Conclusion

It is recommended that the newly developed or translated self-reported measure should be tested for both patient administrated and clinician administrated compatibility. Questionnaires could be administrated by the clinician in the case when the patient is illiterate or in the case when the patient does not understand the language of the instrument.

Media Commercials Conveying Awareness Regarding Prevention of Head and Neck Cancer by Focusing on Stigmatized Perspective of Disease: Right or Wrong?

Cancer in the head and neck region is among the most common cancer around the world, the incidence of which keep increasing in past years. Treatment of disease is usually done by the surgical excision which often leads to some degree of facial disfigurements which cause mutilation in patients. Mutilation imparts the feeling of stigma in patients, and patients usually tend to hide facial disfigurements using additional clothing. As a prevention strategy, awareness regarding the disease conveys to the mass population via media commercials. Media commercials which highlight the adverse outcomes of cancer are found to target the stigmatized perspective of disease. On the brighter side, more stigmatized is the patient image in the commercials, more motivation it will create in masses to avoid risk factors like tobacco, smoking and alcohol. But on the darker side, stigmatized commercials create a social environment in which people tend to maintain social distance to cancer patients, and patients have to bear social disapproval by society for their whole life. It reduces the self-esteem and quality of life of patients which affects their overall survival. In the present article, we review the status of stigma in head and neck cancer patients, tools that are available for assessment of stigma, and effects of the stigmatized media commercials on the patient's self-esteem. The present article represents the accurate picture of the problem and highlights the policies which could be employed to balance the paradox of stigmatized media commercials and a healthy social environment for cancer patients.

Validation of the Malay Version of the Shame and Stigma Scale among Cancer Patients in Malaysia

The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876, p < 0.001). The EFA and CFA confirmed that the SSS-M consisted of 16 items in 3 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.

Uso de Cremes de Camomila e Calêndula na Prevenção de Radiodermatites Agudas em Pacientes com Câncer de Cabeça e Pescoço: Ensaio Clínico Randomizado Duplo-Cego

Introdução: A radiodermatite e caracterizada por lesões cutâneas decorrentes da exposição a radiação ionizante, acometendo entre 80%-90% dos pacientes submetidos a radioterapia na região da cabeça e pescoço. Objetivo: Avaliar a efetividade do uso do creme de camomila em relação ao creme de calêndula na prevenção da radiodermatite aguda em participantes submetidos a radioterapia para câncer de cabeça e pescoço. Método: Ensaio clinico randomizado, duplo-cego, prospectivo, com análise quantitativa. Foram avaliados 23 participantes, aleatoriamente designados para o grupo que fez uso do creme de camomila (n=12) ou para o grupo do creme de calêndula (n=11). A pele no campo de irradiação foi avaliada na primeira sessão de radioterapia, a cada cinco sessoes, e após 30 dias do termino do tratamento, de acordo com os critérios da Radiation Therapy Oncology Group (RTOG). Resultados: Os participantes apresentaram radiodermatite em todas as avaliações, do grau 1 ao 3, exceto na primeira avaliação. O nível médio mais elevado foi observado, em ambos os grupos, na sexta avaliação (2,10±0,73 no grupo do creme de camomila e 2,37±0,51 no de calêndula). No grupo camomila, o maior grau de radiodermatite foi o 3, na quinta e sexta avaliações; enquanto, no calêndula, o grau 3 foi observado pela primeira vez na sexta avaliação, permanecendo até a oitava. Não houve diferença estatisticamente significativa nos grupos avaliados. Conclusão: Houve equivalência na efetividade do uso do creme de camomila em relação ao creme calêndula na prevenção de radiodermatites agudas em pacientes com câncer de cabeça e pescoço em radioterapia.

Translation and Cultural Adaptation into Portuguese of the Quality of Dying and Death Scale for Family Members of Patients in Intensive Care Units

The translation and cultural adaptation of the Quality of Dying and Death in Brazil may provide a reliable and reproducible scale for collecting and analyzing data on the process of dying and death, given the absence of Brazilian studies that have produced or used scales in this topic. The purpose of this study was to perform the translation and cultural adaptation of the Quality of Dying and Death (QODD 3.2a) scale for intensive care patients' relatives into Portuguese (Brazil). This methodological study was carried out in a public university of the São Paulo State University (UNESP) medical school, São Paulo, Brazil, in three stages: translation and back-translation by two native-speaking independent professionals, analysis by a committee of specialists, and a pre-test phase. The final version was created by seven experts after making semantic, idiomatic, and cultural changes to 16 items. The results indicated a satisfactory content validation index (CVI ≥ 0.80). This version was applied on 32 relatives of patients who were hospitalized in a public hospital in the interior of São Paulo. No item was excluded from the instrument. The content and face validity were achieved to a satisfactory standard, in addition to reaching the minimum parameters recommended in the literature. The Portuguese version of QODD 3.2a for relatives of deceased patients in intensive care is appropriate and culturally adapted for use in Brazil.

Quality of Life of the Patient with Head and Neck Cancer Submitted to Radiotherapy and the Overload of Their Caregivers

Introduction  Esthetic and functional changes are frequent in patients with head and neck cancer, and they can be caused by both tumor and treatment. Physical and functional impairment often requires the need of a caregiver, who may feel overwhelmed with the tasks of care.

Objective  This study aims to evaluate the quality of life of patients with head and neck cancer submitted to radiotherapy and the overload of their caregivers.

Method  This is a quantitative cross-sectional study with 42 patients with head and neck cancer and 17 caregivers evaluated during the radiotherapy treatment. Patients responded to the following questionnaires: Functional Assessment of Cancer Therapy for Head and Neck Cancer (FACT-H&N) and Shame and Stigma Scale (SSS), while the caregivers responded to the Zarit Burden Interview Scale (ZBI) and Palliative Performance Scale (PPS).

Results  Head and neck cancer patients showed a decline in the quality of life in all FACT-H&N domains, with the domain of additional concerns having the worst outcome. Among the feelings reported by patients, the most important was penitence. Less than half of the patients needed caregivers. It was observed that the greater the degree of commitment of the patient, the greater the degree of overload of the caregiver.

Conclusion  Therefore, the quality of life of the patient with head and neck cancer is an important aspect to be considered during the therapeutic choice and in the follow-up of the patient, since it has influenced both the patient and his caregiver.

Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review

BACKGROUND AND AIMS

Oral mucositis is the most common side effect in response to anticancer therapies in the head and neck region. It has a debilitating potential for the health of affected individuals, negatively interfering with nutritional status and quality of life. Due to the great complexity of its pathogenicity, different forms of interventions for prevention and treatment are being studied, including nutritional supplements with vitamin E, zinc and glutamine. This study aimed to review the literature on the influence of nutrients, in supplement form, for prevention and/or treatment of mucositis in patients with head and neck cancer.

METHODS

A survey of studies related to the definition, treatment and prevention of mucositis with nutrients was carried out between January 2018 and July 2019, using the Pubmed, Cochrane Library and Scielo databases. In the end, 61 relevant scientific publications were selected between the years 2004 and 2019.

RESULTS

Nutrients such as vitamin E, glutamine and zinc are forms of supplementation that have positive effects on the manifestation and severity of oral mucositis due to their antioxidant and immunomodulatory properties. However, some studies reveal that antioxidant properties may reduce the effectiveness of antineoplastic therapy.

CONCLUSIONS

This study suggests the effectiveness of vitamin E, zinc and glutamine in preventing and treating oral mucositis. However, the importance of new clinical researches to clarify possible doubts is highlighted, as well as the creation of a protocol that includes the dose, route and time of administration, for greater safety in use.

Validation of the Chinese Version of the Shame and Stigma Scale in Patients with Head and Neck Cancer

Purpose

Head and neck cancer (HNC) patients suffer from perceived shame and stigma due to the illness diagnosis, as well as disfigurement following surgery. To measure HNC patients' perception of shame and stigma, the Shame and Stigma Scale (SSS) was developed and preliminarily validated. In this study, we aimed to translate, adapt, and validate the SSS in Chinese.

Methods

This study consisted of a cross-sectional design with consecutive sampling and consisted of two stages: (1) translation of the SSS into Chinese by two bilingual professionals and (2) examination of the Chinese version of the SSS (C-SSS) for internal consistency, inter-rater reliability, test-retest reliability, construct validity, and concurrent validity. In total, 159 inpatients with HNC (mean age: 56.8 years, 95% males) were enrolled at a medical center in Southern Taiwan.

Results

The Principal Component Analysis of the C-SSS revealed a five-factor structure: 4 of the 5 factors were replicated in the original SSS, including Shame with Appearance, Regret, Social/Speech Concern, and Sense of Stigma; only factor 4, Self-discrimination, was newly identified in the current study. C-SSS showed acceptable internal validity (Cronbach's α =0.85), test-retest reliability, inter-rater reliability, and fair concurrent validity with the Taiwanese Depression Questionnaire (TDQ), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Explanatory Model Interview Catalogue (EMIC).

Conclusion

The findings of this study indicate that C-SSS is a reliable and valid instrument for evaluating HNC patients' perception of shame and stigma in the Taiwanese population.

Validation of the Brazilian version of the Shame and Stigma Scale (SSS-Br) for patients with head and neck cancers

OBJECTIVE

To evaluate the psychometric properties of the Brazilian version of the Shame and Stigma Scale (SSS) in a sample of patients with head and neck cancers (HNC).

METHODS

This is a validation study carried out in a Brazilian cancer hospital. Patients over 18 years old who knew about their HNC diagnosis were consecutively recruited, answering the SSS, the Functional Assessment of Cancer Therapy (General and Head and Neck supplement) questionnaire, and the University of Washington Quality of Life Questionnaire. Internal consistency, test-retest procedure, convergent validity, and responsiveness analysis were the psychometric properties evaluated.

RESULTS

A total of 122 HNC patients were included. The SSS showed appropriate internal consistency (alphas ranging from 0.71 to 0.86), test-retest reliability (higher than 0.92 with exception of the "Regret domain"), and convergent validity. The responsiveness analysis with 38 patients was able to discriminate the scores before and after prosthetic procedures.

SIGNIFICANCE OF THE RESULTS

The Brazilian Portuguese version of the SSS may be considered a valid and reliable instrument for the evaluation of Brazilian patients with HNC. Future SSS validation studies are welcome in other developing countries in order to make cancer health providers aware of these negative feelings in their HNC patients.