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Ninnoni JP, Agyemang SO, Bennin L, Agyare E, Gyimah L, Senya K, Baddoo NA, Annor F, Obiri-Yeboah D. Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study. BMC Psychiatry 2023; 23:163. [PMID: 36918875 PMCID: PMC10013231 DOI: 10.1186/s12888-023-04643-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Challenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting. METHODS This was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated. RESULTS The mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4-99.7) and loneliness of 30.1% (95%CI = 25.6-34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems. CONCLUSION The results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.
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Affiliation(s)
- Jerry Paul Ninnoni
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
- Department of Mental Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Sampson Opoku Agyemang
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Lydia Bennin
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Leveana Gyimah
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Kafui Senya
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Nyonuku Akosua Baddoo
- National AIDS/STIs Control Programme, Accra, Ghana
- Department of Community Health, the University of Ghana Medical School, Accra, Ghana
| | - Francis Annor
- Direcctorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Dorcas Obiri-Yeboah
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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2
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Pape E, Decoene E, Debrauwere M, Van Nieuwenhove Y, Pattyn P, Feryn T, Pattyn PRL, Verhaeghe S, Van Hecke A. The trajectory of hope and loneliness in rectal cancer survivors with major low anterior resection syndrome: A qualitative study. Eur J Oncol Nurs 2021; 56:102088. [PMID: 34942590 DOI: 10.1016/j.ejon.2021.102088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Rectal cancer survivors are often confronted with long-term bowel function impairment, called low anterior resection syndrome. This has a large impact on patients' lives. The aim was to explore the experiences of patients with major low anterior resection syndrome with a specific focus on hope and loneliness. METHODS A grounded theory approach was used. Individual semi-structured interviews (n = 28) were performed between 2017 and 2019. Patients were recruited in three hospitals and a call was distributed in two patients' organizations. During data analysis, the constant comparative method and investigators' triangulation was used. RESULTS Hope was important at different stages in the trajectory. After treatment patients hoped to pick up their previous life. Confrontation with low anterior resection syndrome was unexpected and patients hoped to manage it through trial and error. They lost hope if further improvement was absent. At that turning point some tried to accept the new lifestyle, others pushed their boundaries and some opted for a permanent stoma. Loneliness presented itself in several layers. Patients experience loneliness due being toilet-bound, changes in their lives and activities outside their homes and the impact on their family life. CONCLUSION Assessment of the impact on patients' lives and tailored counselling is possible if healthcare professionals gain more insight into the different layers of loneliness and where the patient is located in the trajectory of hope.
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Affiliation(s)
- E Pape
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
| | - E Decoene
- Cancer Centre, Ghent University Hospital, Ghent, Belgium
| | - M Debrauwere
- Intravenous Vascular Access Team, Ghent University Hospital, Ghent, Belgium
| | - Y Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - P Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - T Feryn
- Department of Surgery, AZ Sint-Jan Bruges, Belgium
| | - P R L Pattyn
- Department of Surgery, AZ Delta Roeselare, Belgium
| | - S Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - A Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
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3
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Igarashi N, Aoyama M, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Are cancer patients living alone more or less likely to achieve a good death? Two cross-sectional surveys of bereaved families. J Adv Nurs 2021; 77:3745-3758. [PMID: 34028846 DOI: 10.1111/jan.14886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/12/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
This study examined differences in sociodemographic characteristics and the achievement of a good death between cancer patients who live alone and those who do not live alone prior to death in different settings. Secondary analysis of data collected across two cross-sectional self-reported questionnaire surveys was undertaken. The participants were bereaved family members of cancer patients who had died in palliative care units (PCUs), acute hospitals or homes. We stratified the data by the place of death and examined the differences in sociodemographic characteristics to determine the relationship between cancer patients achieving a "good death" and whether they were living alone. The data were collected through 15,949 surveys. On the Good Death Inventory, significantly higher total scores emerged for cancer patients who were living alone than for those who not living alone in PCUs (effect size [ES] = 0.11, Student's t-test: p < .0001), but not in acute hospitals (ES = -0.03, p = 0.74) or home care services (ES = 0.02, p = 0.86). Cancer patients who were living alone were more likely to have been female, been older and have earned a lower annual income than those who were not living alone. Thus, among those who had received specialized palliative care, there was no difference in the quality of palliative care between cancer patients who were or were not living alone.
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Affiliation(s)
- Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tatsuya Morita
- Palliative and Supportive care Division, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Foundation, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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4
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Deckx L, Chow KH, Askew D, van Driel ML, Mitchell GK, van den Akker M. Psychosocial care for cancer survivors: A systematic literature review on the role of general practitioners. Psychooncology 2021; 30:444-454. [PMID: 33314485 DOI: 10.1002/pon.5612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the general practitioners (GP's) role in providing psychosocial care for cancer survivors through a systematic literature review. METHODS We searched MEDLINE, EMBASE, PsycINFO, and CINAHL and included the studies that complied with the predefined inclusion and exclusion criteria. At least two independent reviewers performed the quality appraisal and data extraction. RESULTS We included 33 (five qualitative, 19 observational, and nine intervention) studies; the majority of these studies focused on care for depression and anxiety (21/33). Cancer survivors were more likely to contact their GP for psychosocial problems compared with noncancer controls. Survivors were more likely to use antidepressants compared with controls, although 71% of survivors preferred depression treatment to be "talking therapy only." Overall, GPs and patients mostly agreed that GPs are the preferred healthcare provider to manage psychosocial problems. The major exception is a survivor's fear of recurrence-here, the oncologist was the preferred healthcare provider. Only two interventions effectively decreased depression or anxiety; these studies included patients who had a clinical indication for psychosocial care, were specifically designed for decreasing depression/anxiety, and consisted of a multidisciplinary team approach. The other interventions evaluated GP-led follow-up for cancer survivors and found that this did not impact the patients' levels of anxiety, depression, or distress neither negatively nor positively. CONCLUSIONS Cancer survivors often prefer psychosocial care by their GP, and GPs generally consider they are well placed to provide this care. Although evidence on the effectiveness of psychosocial care by GPs is limited, an active multidisciplinary team approach seems key.
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Affiliation(s)
- Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ka Hei Chow
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Deborah Askew
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Geoffrey K Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany.,Academic Centre for General Practice, KU Leuven, Leuven, Belgium.,Department of General Practice, Maastricht University, Maastricht, The Netherlands
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5
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Park C, Majeed A, Gill H, Tamura J, Ho RC, Mansur RB, Nasri F, Lee Y, Rosenblat JD, Wong E, McIntyre RS. The Effect of Loneliness on Distinct Health Outcomes: A Comprehensive Review and Meta-Analysis. Psychiatry Res 2020; 294:113514. [PMID: 33130511 DOI: 10.1016/j.psychres.2020.113514] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
The primary objective was to evaluate the comparative effects of loneliness on multiple distinct health outcomes. The literature was qualitatively reviewed to identify loneliness risk factors, explore mechanisms, and discuss potential evidence-based interventions for targeting loneliness. 114 identified studies were systematically reviewed and analyzed to examine for associations between loneliness (as measured by the UCLA Loneliness or de Jong Gierveld Loneliness Scales) and one or more health outcome(s). Health outcomes were broadly defined to include measures of mental health (i.e., depression, anxiety, suicidality, general mental health), general health (i.e., overall self-rated health), well-being (i.e., quality of life, life satisfaction), physical health (i.e., functional disability), sleep, and cognition. Loneliness had medium to large effects on all health outcomes, with the largest effects on mental health and overall well-being; however, this result may have been confounded by the breadth of studies exploring the association between loneliness and mental health, as opposed to other health outcomes. A significant effect of gender on the association between loneliness and cognition (i.e., more pronounced in studies with a greater proportion of males) was also observed. The adequate training of health care providers to perceive and respond to loneliness among patients should be prioritized.
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Affiliation(s)
- Caroline Park
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Tamura
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Wong
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
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6
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Dahill A, Al-Nakishbandi H, Cunningham K, Humphris G, Lowe D, Rogers S. Loneliness and quality of life after head and neck cancer. Br J Oral Maxillofac Surg 2020; 58:959-965. [DOI: 10.1016/j.bjoms.2020.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/28/2020] [Indexed: 02/09/2023]
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7
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Alcorn J, Burton R, Topping A. Withdrawing from treatment for Bladder cancer: Patient experiences of
BCG
installations. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jason Alcorn
- Mid Yorkshire Hospitals NHS Trust Pinderfields Hospital Wakefield West Yorkshire UK
| | - Rob Burton
- School of Nursing and Midwifery Griffith University Mount Gravatt Queensland Australia
| | - Annie Topping
- School of Nursing University of Birmingham & University Birmingham Hospitals NHS Foundation Trust Birmingham UK
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8
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Karimi SE, Rafiey H, Sajjadi H, Nosrati Nejad F. Identifying the Social Determinants of Breast Health Behavior: a Qualitative Content Analysis. Asian Pac J Cancer Prev 2018; 19:1867-1877. [PMID: 30049199 PMCID: PMC6165651 DOI: 10.22034/apjcp.2018.19.7.1867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/08/2018] [Indexed: 11/27/2022] Open
Abstract
Background: Prevention, early diagnosis and reduction of mortality caused by breast cancer are the priorities of the world health systems. The aim of this study was to identify the social factors that affect the women’s breast health behavior based on the social determinants model of the World Health Organization (WHO). Materials and Method: This qualitative study was conducted and analyzed using content analysis approach. The data were collected from 32 participants by semi-structured interviews and focused group discussion. The participants comprised of breast surgeons, radiologists, health care providers and women over 35 years of age in Tehran who were selected through purposeful sampling. The interviews continued until data saturation was reached. Results: Based on the experiences of the participants, three themes were obtained from the data that shaped the women’s breast health behavior, including 1) the context of health policy, 2) socioeconomic status, and 3) cultural, psychological, and behavioral factors. Conclusion: A better understanding of social determinants related to breast health behavior can be effective in designing and applying of appropriate theories and models of education and intervention, so that, by early diagnosis of breast cancer and timely treatment of patients, the disease complications and mortality would be reduced.
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Affiliation(s)
- Salah Eddin Karimi
- Social welfare management department, University of social Welfare and Rehabilitation Sciences, Tehran, Iran.
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9
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Skirbekk H, Korsvold L, Finset A. To support and to be supported. A qualitative study of peer support centres in cancer care in Norway. PATIENT EDUCATION AND COUNSELING 2018; 101:711-716. [PMID: 29191626 DOI: 10.1016/j.pec.2017.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To explore what peer supporters, patients and their relatives want and gain from peer support in cancer care. METHODS Focus group interviews with peer supporters, and in-depth interviews with peer supporters, patients and relatives (N=38) and observations of daily activities in a Vardesenter ("Cairn Centre"). RESULTS Peer supporters helped cancer patients and relatives with coping in and outside the hospital in several ways: (1) conveying hope and providing ways to cope in situations where despair would often be prevalent, thus protecting against unhealthy stress; (2) being someone who had the same experiences of disease and treatment, and thus providing a framework for positive social comparisons; and (3) to be an important supplement to family and health care providers. To be working as a peer supporter was also found to be positive and important for the peer supporters themselves. CONCLUSION The peer support program represented a valuable supplement to informal support from family and friends and healthcare providers, and gave the peer supporters a new role as "professionally unprofessional". PRACTICE IMPLICATIONS Organised peer support represents a feasible intervention to promote coping for cancer survivors.
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Affiliation(s)
- Helge Skirbekk
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Norway; Faculty of Business Administration, Inland Norway University of Applied Sciences, Norway; Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Live Korsvold
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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10
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Threats to Belonging among Breast Cancer Survivors: Consequences for Mental and Physical Health. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0262-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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11
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Cunningham KB, Kroll T, Wells M. Development of the cancer-related loneliness assessment tool: Using the findings of a qualitative analysis to generate questionnaire items. Eur J Cancer Care (Engl) 2017; 27:e12769. [PMID: 28913913 DOI: 10.1111/ecc.12769] [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] [Accepted: 08/04/2017] [Indexed: 11/26/2022]
Abstract
The aim of this research was to develop a tool to identify and assess the qualities of cancer-related loneliness in adult cancer survivors who have completed treatment. In addition to reporting the development of the tool, we explicate the process of using the findings of a qualitative analysis to generate questionnaire items, as currently little guidance exists on this topic. The findings of our qualitative research exploring the experience of loneliness in adult cancer survivors who had completed treatment, together with the findings of our concept analysis of loneliness, were used to develop an assessment tool for cancer-related loneliness following treatment completion. Cognitive testing was undertaken to assess fidelity of comprehension and feasibility in administration. The Cancer-Related Loneliness Assessment Tool is a 10-item self-report questionnaire capturing the essential elements of cancer-related loneliness following treatment completion. Experts believed the questionnaire to be face-valid and usable in clinical practice, and preliminary cognitive testing indicated that the items generate the information intended and individuals have little trouble completing the tool. Following further development work, the tool could be employed to identify cancer-related loneliness following treatment completion. It could also aid with the development/adaptation and evaluation of person-centred interventions to address such loneliness.
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Affiliation(s)
| | - T Kroll
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - M Wells
- NMAHP Research Unit, University of Stirling, Stirling, UK
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12
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Adams RN, Mosher CE, Rand KL, Hirsh AT, Monahan PO, Abonour R, Kroenke K. The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation. Qual Life Res 2017; 26:1901-1913. [PMID: 28236266 DOI: 10.1007/s11136-017-1518-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Loneliness is a known risk factor for poor mental and physical health outcomes and quality of life in the general population, and preliminary research suggests that loneliness is linked to poorer health outcomes in cancer patients as well. Various aspects of the cancer experience contribute to patients feeling alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Cancer-specific tools are needed to assess key constructs of this theory. In the current study, we developed and tested measures of (1) loneliness attributed to cancer (i.e., cancer-related loneliness) and (2) negative social expectations related to cancer. METHODS First, we developed the items for the measures based on theory, prior research, and expert feedback. Next, we assessed the measures' psychometric properties (i.e., internal consistency and construct validity) in a diverse sample of cancer patients. RESULTS The final products included a 7-item unidimensional Cancer Loneliness Scale and a 5-item unidimensional Cancer-related Negative Social Expectations Scale. Evidence of excellent reliability and validity was found for both measures. CONCLUSIONS The resulting measures have both clinical and research utility.
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Affiliation(s)
- Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, 780 Welch Road, MC 5776, Palo Alto, CA, 94304, USA.
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, 410 W. Tenth St., Suite 3000, Indianapolis, IN, 46202, USA
| | - Rafat Abonour
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Drive, Indiana Cancer Pavilion, Suite 446, Indianapolis, IN, 46202, USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc. (RF), 1101 West Tenth Street, RF 221, Indianapolis, IN, 46202, USA
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13
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Adams RN, Mosher CE, Abonour R, Robertson MJ, Champion VL, Kroenke K. Cognitive and Situational Precipitants of Loneliness Among Patients With Cancer: A Qualitative Analysis. Oncol Nurs Forum 2017; 43:156-63. [PMID: 26906127 DOI: 10.1188/16.onf.156-163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE/OBJECTIVES To identify situations and thoughts that may precipitate or protect against loneliness experienced by patients with cancer.
RESEARCH APPROACH Qualitative.
SETTING The hematology/oncology clinic at the Indiana University Melvin and Bren Simon Cancer Center, an outpatient oncology center in Indianapolis.
PARTICIPANTS Purposive sample of 15 patients undergoing treatment for multiple myeloma or non-Hodgkin lymphoma.
METHODOLOGIC APPROACH Individual, semistructured qualitative interviews were conducted. Theoretical thematic analysis was used to analyze interview data.
FINDINGS Factors that appeared to precipitate loneliness included several situations (e.g., physical isolation, social constraints such as criticism) and thoughts (e.g., unmet expectations for visits or questions about health, belief that others do not understand their cancer experience). Several situations (e.g., social support, normal routine) and thoughts (e.g., beliefs that time alone is desirable and that others' discomfort with cancer-related discussions is normative) appeared to protect against loneliness. Certain social situations were loneliness-inducing for some patients and not for others, suggesting that patients' thoughts about their situations, rather than the situations themselves, have the greatest impact on their loneliness.
CONCLUSIONS The current study fills gaps in loneliness theory by identifying cancer-related situations and thoughts that patients associate with their loneliness. Consistent with theory, patients reported feeling lonely when they had negative thoughts about their social situations.
INTERPRETATION Findings inform nursing assessment and intervention strategies to incorporate into care plans. For instance, when conducting assessments, nurses should be more attentive to patients' satisfaction with their social environment than actual characteristics of the environment. Normalizing patients' experiences and encouraging positive thoughts about others' behavior may reduce patients' loneliness.
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Affiliation(s)
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University in Indianapolis
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14
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Khng JNW, Woo IMH, Fan G. Experiential group work for cancer patients shaped by experiences of participants during group intervention. Future Oncol 2016; 12:2817-2822. [PMID: 27750458 DOI: 10.2217/fon-2016-0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cancer tends to have an impact on a person's psychological and social well-being. Group work is one approach that can help manage the psychosocial impact of cancer. Group interventions for people living with cancer have existed for a number of decades with a majority of them adopting the cognitive-behavioral approach. While this approach has been found to be efficacious, it may be limited for people who prefer acts of service and metaphors. This article describes an experiential approach to group intervention, an alternative to cognitive-behavioral groups. The group intervention featured is designed for participants of Enreach Retreat, a retreat for people living with cancer and their caregivers, by the Department of Psychosocial Oncology, National Cancer Centre Singapore.
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Affiliation(s)
- Joan Nee Wey Khng
- Department of Social Work, National University of Singapore, Faculty of Arts and Social Sciences, Blk AS3, Level 4, 3 Arts Link, Singapore 117570
| | - Ivan Mun Hong Woo
- Department of Care & Counselling, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Gilbert Fan
- Department of Psychosocial Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
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15
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Wells M, Cunningham M, Lang H, Swartzman S, Philp J, Taylor L, Thomson J. Distress, concerns and unmet needs in survivors of head and neck cancer: a cross-sectional survey. Eur J Cancer Care (Engl) 2015; 24:748-60. [DOI: 10.1111/ecc.12370] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 12/12/2022]
Affiliation(s)
- M. Wells
- NMAHP Research Unit; Scion House; University of Stirling; Stirling UK
| | - M. Cunningham
- NMAHP Research Unit; Scion House; University of Stirling; Stirling UK
| | - H. Lang
- School of Nursing and Midwifery; University of Dundee; Dundee UK
| | - S. Swartzman
- School of Psychology; University of Dundee; Dundee UK
| | - J. Philp
- Head and Neck Cancer Service; Queen Margaret Hospital; Dunfermline UK
| | | | - J. Thomson
- Medicine & Surgery; King Abdulaziz Medical City; Jeddah Saudi Arabia
- NHS Forth Valley; UK
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16
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Deckx L, van den Akker M, van Driel M, Bulens P, van Abbema D, Tjan-Heijnen V, Kenis C, de Jonge ET, Houben B, Buntinx F. Loneliness in patients with cancer: the first year after cancer diagnosis. Psychooncology 2015; 24:1521-8. [PMID: 25914244 DOI: 10.1002/pon.3818] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 03/02/2015] [Accepted: 03/14/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We studied the frequency and evolution of social and emotional loneliness in older cancer patients in comparison with younger cancer patients and older people without cancer. We evaluated if changes in common cancer-related and ageing-related problems such as fatigue, cognitive functioning and functional status contributed to the occurrence of loneliness. METHODS This study was part of the KLIMOP study (Dutch acronym for project on older cancer patients in Belgium and the Netherlands) and included older (≥70 years) and younger cancer patients (50-69 years) and older people without cancer. Data were collected at baseline and 1-year follow-up. Loneliness was measured with the loneliness scale of De Jong-Gierveld. The relationship between loneliness after 1 year and changes in fatigue, cognitive functioning and functional status was tested in multivariate logistic regression analyses. RESULTS Data were available for 475 participants. At baseline, older cancer patients were less lonely compared with older people without cancer. After 1 year, the frequency of emotional loneliness had significantly increased for older cancer patients (26-42%, p < 0.001) and had reached levels of older people without cancer. Emotional loneliness also increased for younger cancer patients (25-34%, p = 0.02), but not for older people without cancer (40-38%, p = 0.69). Frequency of social loneliness did not change significantly. People who were persistently fatigued and people who became or were persistently impaired on cognitive functioning were at increased risk of becoming lonely. CONCLUSION Loneliness, in particular emotional loneliness, is a common problem in cancer patients, and its frequency changes considerably over time.
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Affiliation(s)
- Laura Deckx
- Department of General Practice, KU Leuven, Leuven, Belgium
| | - Marjan van den Akker
- Department of General Practice, KU Leuven, Leuven, Belgium.,Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Paul Bulens
- Limburgs Oncologisch Centrum, Hasselt, Belgium
| | - Doris van Abbema
- Department of Medical Oncology, School GROW, Maastricht University, Maastricht, the Netherlands
| | - Vivianne Tjan-Heijnen
- Department of Medical Oncology, School GROW, Maastricht University, Maastricht, the Netherlands
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Eric T de Jonge
- Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Bert Houben
- Department of Abdominal and Oncological Surgery, Jessa Hospital, Hasselt, Belgium
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Leuven, Belgium.,Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
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17
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Goossens J, Delbaere I, Beeckman D, Verhaeghe S, Van Hecke A. Communication Difficulties and the Experience of Loneliness in Patients With Cancer Dealing With Fertility Issues: A Qualitative Study. Oncol Nurs Forum 2014; 42:34-43. [DOI: 10.1188/15.onf.34-43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Risk factors for loneliness in patients with cancer: a systematic literature review and meta-analysis. Eur J Oncol Nurs 2014; 18:466-77. [PMID: 24993076 DOI: 10.1016/j.ejon.2014.05.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/07/2014] [Accepted: 05/05/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically review the literature on the severity and risk factors for loneliness in adult cancer patients. METHODS We systematically reviewed quantitative studies addressing loneliness in cancer patients. Exclusion criteria were absence of a validated loneliness questionnaire, and studies that focused on loneliness determined by specific circumstances, and not cancer in general (e.g. appearance concerns, cultural and language barriers, requiring palliative care). We searched PsycINFO, CINAHL, Embase, Cochrane Library, and Pubmed in compliance with the predefined in- and exclusion criteria. The search, quality appraisal, and data extraction were performed by two independent reviewers. Weighted mean scores were calculated by using random effects adjusted inverse variance weighting. RESULTS We included 15 studies. In 13 studies the UCLA loneliness scale was used (range 20-80; higher scores indicate higher loneliness). The weighted mean loneliness score was 38.26 (95% CI: 35.51-41.00), which corresponds to moderate loneliness. Time since diagnosis was positively associated with degree of loneliness. Other cancer-related factors, such as cancer site, treatment type, or stage of disease were not associated with loneliness. The non-cancer related determinants of loneliness in cancer patients that emerged from our review were being unmarried (people who have never been married, are widowed or divorced), and lack of psychological or social support. CONCLUSION Our findings suggest that the level of loneliness rises with increasing time after cancer diagnosis. Furthermore, social functioning emerged as a consistent theme, for which it was shown that lack of social support was associated with increasing levels of loneliness.
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19
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The significance of fellow patients for head and neck cancer patients in the radiation treatment period. Eur J Oncol Nurs 2013; 17:618-24. [DOI: 10.1016/j.ejon.2013.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/19/2012] [Accepted: 01/05/2013] [Indexed: 11/19/2022]
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20
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Egestad H. How does the radiation therapist affect the cancer patients' experience of the radiation treatment? Eur J Cancer Care (Engl) 2013; 22:580-8. [DOI: 10.1111/ecc.12062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2013] [Indexed: 12/01/2022]
Affiliation(s)
- H. Egestad
- Department of Health and Care Sciences; Faculty of Health Sciences; University of Tromsø; Tromsø; Norway
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21
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Hit by waves-living with local advanced or localized prostate cancer treated with endocrine therapy or under active surveillance. Cancer Nurs 2011; 33:382-9. [PMID: 20562621 DOI: 10.1097/ncc.0b013e3181d1c8ea] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies of living with prostate cancer have shown that the illness and the treatment cause physical as well as psychosocial problems. OBJECTIVE The aim of this study was to illuminate men's experiences living with localized or local advanced prostate cancer when curative treatment such as surgery or radiation therapy is not an option at the time of diagnosis. METHODS The study was conducted via qualitative interviews, using a phenomenological hermeneutic approach. Ten men treated with endocrine therapy or under active surveillance were interviewed. RESULTS Being diagnosed with prostate cancer was described as a shock, with different aspects of the illness revealed gradually. The limited amount of time available for meeting with health care providers contributed to patients' feelings of being left alone with difficulty getting information and help. Sexual and urinary problems were perceived as a threat to their manhood. The spouses provided the closest everyday support. CONCLUSION The life situation of these patients can be understood as living in a "state of readiness," expecting something to happen regarding their illness, and not always knowing where to get help. IMPLICATIONS FOR PRACTICE The results confirm existing knowledge of patient's experiences in living with prostate cancer regarding the initial shock perceived by the patients, the bodily alterations, and the important role of their spouses. Nurses, as well as general practitioners, must play a more active role in follow-up to ensure that the men and their spouses receive better help and support.
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Left hanging in the air: experiences of living with cancer as expressed through E-mail communications with oncology nurses. Cancer Nurs 2011; 34:107-16. [PMID: 20921887 DOI: 10.1097/ncc.0b013e3181eff008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer patients experience many physical, psychosocial, and existential problems and worries during their illness. To support patients in managing their illness, we implemented an online patient-nurse communication (OPNC) service, where breast and prostate cancer patients could ask questions and receive advice from oncology nurses. OBJECTIVE The aim of this study was to explore the use and content of patients' e-mail messages sent to oncology nurses and thus gain a "snapshot" of patients' experiences of living with cancer as expressed through these messages. METHODS Using qualitative content analysis, 276 messages from 60 breast and prostate cancer patients were analyzed. Messages were coded into categories and major themes. Both manifest and latent content was coded. RESULTS Four main themes emerged from patients' messages: (1) living with symptoms and side effects, (2) living with a fear of relapse, (3) concerns for everyday life, and (4) unmet information needs from health care providers. CONCLUSIONS Patients used the OPNC service actively to pose questions and raise concerns related to symptom experiences, fear of relapses, and uncertainty in everyday life. However, patients also expressed experiences of being "left in a void" after being discharged from hospital and living with serious unmet informational needs. IMPLICATIONS FOR PRACTICE The study demonstrated that online communication can provide patients with a space for otherwise unmet questions and worries and that they will seek support from nurses online when given the opportunity. Therefore, OPNC can be an important means and supplement to traditional health care in the effort to support patients to better manage their illness.
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