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Prizeman K, Weinstein N, McCabe C. Strategies to overcome mental health stigma: Insights and recommendations from young people with major depressive disorder (MDD). Brain Behav 2024; 14:e70028. [PMID: 39295100 PMCID: PMC11410881 DOI: 10.1002/brb3.70028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Young people with depression are met with stigma related to their mental health, which exacerbates loneliness, social isolation, and depression symptoms. While disclosing depression could improve one's mental health, stigma can also make social interactions more challenging and reduce the likelihood of receiving treatment. This research explored young people's experiences with stigma and recommendations for addressing it. METHODS Semi-structured interviews conducted with N = 35 young people aged 18-25 years (Mage = 20.09) were analyzed with thematic analysis. Participants met the criteria for clinical depression using the Mood and Feelings Questionnaire (score >27) or had recently obtained a medical diagnosis (N = 18) of depression by a medical professional. RESULTS Participants faced stigma when deciding to disclose their depression, which fed into a vicious cycle influencing feelings of loneliness, social isolation, and withdrawal. Their recommendations for others to avoid this cycle can be summarized under three main themes: (1) Social affirmation: identify allies and build meaningful connections; (2) Self-affirmation: build a constructive relationship with the self; and (3) Societal affirmation: structural changes are needed. CONCLUSIONS The current research indicates that social, self-, and societal affirmation are considered important for reducing the detrimental impacts of stigma. Policies and programs are needed that provide mental health support to young people, and public awareness campaigns that guide young people to appropriate resources (i.e., support and intervention) via governmental public health bodies.
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Affiliation(s)
- Katie Prizeman
- Department of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Netta Weinstein
- Department of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Ciara McCabe
- Department of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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Jafari A, Mokhtari AM, Moshki M, Rahmani F, Naddafi F, Nejatian M. Psychometric properties of the Persian short form of the Stigma of Suicide Scale. Front Psychiatry 2024; 15:1394237. [PMID: 39132317 PMCID: PMC11310839 DOI: 10.3389/fpsyt.2024.1394237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/01/2024] [Indexed: 08/13/2024] Open
Abstract
Objective Suicide stigma is a major obstacle to suicide prevention, resulting in a decrease in mental help seeking. This study aimed to survey the psychometric characteristics of the Persian short form of the Stigma of Suicide Scale (SOSS). Methods This psychometric study was conducted on 956 people (EFA = 399 samples, CFA = 557) in 2022 to evaluate the validity (face, content, and structure validity) and reliability (Cronbach's alpha coefficient, McDonald Omega coefficient, and intraclass correlation coefficient) of the SOSS. The structural validity of the scale was assessed by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results The scores of S-CVI/Ave and CVR for SOSS were 0.982 and 0.921, respectively. In the EFA section, three factors with eigenvalues above one were shown, and 60.60% variance of the scale was explained by these factors, and one question was eliminated due the factor loading less than 0.4 and also moving to an irrelevant factor. Finally, based on the goodness-of-fit indices (such as RMSEA = .077, CFI= .902, IFI= .903, GFI= .915), the Persian short form of SOSS was approved with 15 items and three factors of Glorification/Normalization (4 items), Stigma (7 items), Isolation/Depression (4 items). The McDonald Omega coefficient, Cronbach's alpha coefficient, and ICC for SOSS were 0.841, 0.834, and 0.881, respectively. Conclusion In this study, the Persian short form of the SOSS was approved with 15 items and 3 factors, and this scale is an appropriate instrument for determining the status of suicide stigma among general population.
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Affiliation(s)
- Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Mohammad Mokhtari
- Department of Epidemiology and Biostatistics, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mahdi Moshki
- Department of Health Education and Health Promotion, School of Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemeh Rahmani
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemehzahra Naddafi
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mahbobeh Nejatian
- Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Mercado M, Law L, Ferguson-Colvin K, Wolfersteig W. Intersectional Structural Stigma: A Qualitative Study With Persons Experiencing Homelessness in the Southwest United States. QUALITATIVE HEALTH RESEARCH 2024:10497323241239209. [PMID: 38902919 DOI: 10.1177/10497323241239209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12-17), young adults (ages 18-24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups (n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers.
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Affiliation(s)
- Micaela Mercado
- School of Social Work, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | - Lara Law
- School of Social Work, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | | | - Wendy Wolfersteig
- School of Social Work, Arizona State University, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
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Johnson SE, Samson M. Cancer stigma: the need for policy and programmatic action. J Natl Cancer Inst Monogr 2024; 2024:45-50. [PMID: 38836525 DOI: 10.1093/jncimonographs/lgae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 03/20/2024] [Indexed: 06/06/2024] Open
Abstract
Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.
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Affiliation(s)
| | - Mélanie Samson
- Capacity Building, Union for International Cancer Control, Geneva, Switzerland
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Estrada JAG. Unraveling socioeconomic determinants of health-related behavior, reception of information, and perceptions on disease disclosure at the time of the COVID-19 pandemic: did health insurance curb the disparities in the Philippines? BMC Public Health 2024; 24:767. [PMID: 38475807 DOI: 10.1186/s12889-024-18264-9] [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: 08/01/2023] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic. METHODS This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects. RESULTS Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing. CONCLUSION It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.
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Elshami M, Sawafta N, Mansour A, Alser M, Al-Slaibi I, Abukmail H, Shurrab H, Qassem S, Usrof FD, Alruzayqat M, Aqel W, Nairoukh R, Kittaneh R, Habes YMN, Ghanim O, Aabed WA, Omar O, Daraghma M, Aljbour J, Elian REM, Zuhour A, Habes H, Al-Dadah M, Albarqi SI, Bottcher B, Abu-El-Noor N. Anticipated time to seek medical advice for possible lung cancer symptoms and barriers to timely presentation in Palestine: a national cross-sectional study. BMC Cancer 2024; 24:183. [PMID: 38326766 PMCID: PMC10848550 DOI: 10.1186/s12885-024-11935-1] [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: 09/03/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Lung cancer (LC) has poor survival outcomes mainly due to diagnosis at late stages. This study explored the anticipated time to seek medical advice for possible LC symptoms and barriers to early presentation in Palestine. METHODS This cross-sectional study recruited adult participants from hospitals, primary healthcare centers, and public spaces of 11 governorates using convenience sampling. A modified, translated-into-Arabic version of the validated LC awareness measure was used to assess LC symptom awareness, the time needed to seek medical advice and barriers to early presentation. RESULTS A total of 4762 participants were included. The proportion that would immediately seek medical advice for possible LC symptoms varied according to the symptoms' nature. For respiratory symptoms, this ranged from 15.0% for 'painful cough' to 37.0% for 'coughing up blood'. For non-respiratory symptoms, this ranged from '4.2% for 'unexplained loss of appetite' to 13.8% for 'changes in the shape of fingers or nails'. Participants with good LC symptom awareness were more likely to seek medical advice within a week of recognizing most LC symptoms. About 13.0% would delay their visit to see a doctor after recognizing an LC symptom. The most reported barriers were emotional with 'disliking the visit to healthcare facilities' (59.8%) as the leading barrier. CONCLUSION LC respiratory symptoms were more likely to prompt early seeking of medical advice. Good LC symptom awareness was associated with a higher likelihood of help-seeking within a week. Educational interventions are needed to promote LC awareness and address the perceived barriers to early presentation in low-resource settings, such as Palestine.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH, 44106, USA.
- Ministry of Health, Gaza, Palestine.
| | - Nawras Sawafta
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Ahmad Mansour
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- Ministry of Health, Ramallah, West Bank, Palestine
| | - Mohammed Alser
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
- The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Gaza, Palestine
| | | | - Hanan Abukmail
- International Medical Corps, Gaza, Palestine
- Harvard Medical School, Boston, MA, USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hanan Shurrab
- Faculty of Pharmacy, Al-Azhar University of Gaza, Gaza, Palestine
| | - Shahd Qassem
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Faten Darwish Usrof
- Department of a Medical Laboratory Sciences, Faculty of Health Sciences, Islamic University of Gaza, Gaza City, Palestine
| | | | - Wafa Aqel
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Roba Nairoukh
- Faculty of Dentistry, Al-Quds University, Jerusalem, Palestine
| | - Rahaf Kittaneh
- Faculty of Nursing, An Najah National University, Nablus, Palestine
| | | | - Obaida Ghanim
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ola Omar
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Motaz Daraghma
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Jumana Aljbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Razan E M Elian
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Areen Zuhour
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Haneen Habes
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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Chansky K, Rigney M, King JC. Real-world analysis of the relationships between smoking, lung cancer stigma, and emotional functioning. Cancer Med 2024; 13:e6702. [PMID: 38214107 PMCID: PMC10905230 DOI: 10.1002/cam4.6702] [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: 06/21/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION People diagnosed with lung cancer experience high rates of distress, which can be compounded by the stigma of the disease. This study assessed a real-world population to understand patient-reported emotional functioning, types of stigma experienced, and relationship with smoking history. METHODS Questionnaires using validated survey tools assessing demographics, smoking history, stigma, and quality of life (EORTC QLQ-C30 Emotional Functioning Scale) were analyzed from 539 global participants in the Lung Cancer Registry between November 2019 and July 2022. The associations between smoking history and self-reported internalized and perceived stigma and constrained disclosure of lung cancer diagnosis, as well as the potential impact of stigma on emotional functioning, were examined using multivariable logistic regression models. RESULTS Among the broad geographic mix of study participants, all types of lung cancer stigma were associated with decreased emotional functioning due to a combination of factors including depression, anxiety, stress, and irritability. Participants who reported a history of current or former smoking experienced higher levels of internalized stigma and perceived stigma. Constrained disclosure about a diagnosis was common, associated with decreased emotional functioning, and not related to a history of smoking. Smoking status itself was not associated with reduced emotional functioning, implicating the role of stigma in distress. CONCLUSIONS In this study, all types of lung cancer stigma were associated with clinically important decreases in emotional functioning. This impact was not dependent on smoking history. Internalized and perceived stigma were associated with the presence of a smoking history. These findings have implications for proper psychosocial care of people diagnosed with lung cancer.
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Affiliation(s)
- Kari Chansky
- Chansky Consulting LLC Mercer IslandMercer IslandWashingtonUSA
- Fred Hutchinson Cancer CenterSeattleWashingtonUSA
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Fournier H, Hasdenteufel M, Garrouteigt C, Perie M, Gliksohn A, Jouanne B, Hadj-Rabia S, Arveiler B, Morice-Picard F, Quintard B. The experience of albinism in France: a qualitative study on dyads of parents and their adult child with albinism. BMC Med 2024; 22:40. [PMID: 38281904 PMCID: PMC10823752 DOI: 10.1186/s12916-024-03251-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND To date, almost no research on the psychosocial implications of albinism has been conducted in France and an exploration of albinism-related experiences could be beneficial, in order to better understand this condition. The aim of this study was to examine how French people with albinism and their parents live with and adapt to this condition in all the areas of their lives. METHODS Semi-structured phone interviews were conducted with 9 parent-child dyads, each participating separately. Participants were recruited by convenience sampling, thanks to the combined efforts of a patient association (Genespoir) and professionals from the partner medical referral centers involved in the project. Dyads in which the individual with albinism had any comorbidity were excluded. The interviews were then transcribed and subjected to in-depth thematic analysis. Two codebooks were constructed in a mirrored process: one for people with albinism; the other for their parents. They were finally merged at the end of the coding step. RESULTS Four main categories were identified: personal perceptions and social representations of albinism, difficulties and obstacles encountered by people with albinism, resources and facilitators, and the importance of parent-child functioning. The results indicated that experiences of stigmatization during childhood and adolescence are common and that people with albinism face challenges in adapting to certain obstacles related to their visual impairments (VI) (e.g., inability to drive a car; eye strain...). Parents emerged as one, if not as the main, source of support for people with albinism throughout their development. Although external support systems exist to assist them in various aspects of their lives, some of them primarily rely on their own personal resources to cope. CONCLUSIONS This research highlights the importance of a systemic and transdisciplinary approach to make sure families receive the support that best meets their needs.
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Affiliation(s)
- Hugo Fournier
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France.
| | - Marie Hasdenteufel
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France
| | - Constance Garrouteigt
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France
| | - Mathieu Perie
- National Institute for Research in Digital Science and Technology, Talence, F-33405, France
| | - Antoine Gliksohn
- Genespoir Association, Rennes, F-35000, France
- Global Albinism Alliance, Fontenay-sous-Bois, F-94120, France
| | | | | | - Benoit Arveiler
- CHU Bordeaux, Bordeaux, F-33404, France
- Laboratory of Rare Diseases: Genetics and Metabolism (MRGM) INSERM U1211, University of Bordeaux, Bordeaux, F-33076, France
| | | | - Bruno Quintard
- Laboratory of Psychology (LabPsy) UR 4139, University of Bordeaux, Bordeaux, F-33000, France
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Butler SJ, Louie AV, Sutradhar R, Paszat L, Brooks D, Gershon AS. Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study. Curr Oncol 2023; 30:6397-6410. [PMID: 37504331 PMCID: PMC10377848 DOI: 10.3390/curroncol30070471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.
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Affiliation(s)
- Stacey J Butler
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Lawrence Paszat
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Andrea S Gershon
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Bu L, Chen X, Zheng S, Fan G. Construction of the structural equation model of stigma, self-disclosure, social support, and quality of life of breast cancer patients after surgery-a multicenter study. Front Oncol 2023; 13:1142728. [PMID: 37274271 PMCID: PMC10233134 DOI: 10.3389/fonc.2023.1142728] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose Stigma is common in patients with breast cancer after surgery, which has a negative impact on the quality of life (QOL). This study aimed to investigate the QOL of breast cancer patients after surgery and to analyze the multiple chains mediating effects of self-disclosure and social support between stigma and QOL. Methods A total 292 patients of breast cancer patients after operation were recruited in this study. A questionnaire survey was conducted using the general information questionnaire, the consumer experiences of stigma questionnaire (CESQ), the distress disclosure index(DDI), the perceived social support scale(PSSS), and the functional assessment of cancer therapy-breast(FACT-B). Path analysis was conducted to test the hypothesized serial multiple mediation model. Results The total scores of stigma, self-disclosure, social support and QOL were 15 (10 ~ 22), 39 (31 ~ 46), 58 (50 ~ 67) and 88 (74 ~ 104) respectively. QOL of breast cancer patients after the operation was negatively correlated with stigma (p < 0.01), and positively correlated with self-disclosure and social support (p < 0.01). Self-disclosure and social support played a complete mediating effect between stigma and QOL, and the total mediating effect value was 85. 87%. Conclusions Self-disclosure and social support play a complete intermediary role between stigma and QOL. In order to improve the quality of life of patients, medical staff should pay attention to the assessment of stigma, encourage patients to express their emotions, and encourage their families and friends to respond to their expression and needs of patients.
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Affiliation(s)
- Liuxiu Bu
- Shantou University Medical College, Shantou, China
| | - Xisui Chen
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | | | - Guanhua Fan
- Shantou University Medical College, Shantou, China
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Damsees R, Jaghbir M, Salam M, Al-Omari A, Al-Rawashdeh N. Unravelling the predictors of late cancer presentation and diagnosis in Jordan: a cross-sectional study of patients with lung and colorectal cancers. BMJ Open 2023; 13:e069529. [PMID: 37130680 PMCID: PMC10163555 DOI: 10.1136/bmjopen-2022-069529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Late presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one's chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan. DESIGN This correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used. SETTING AND PARTICIPANTS The study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation. RESULTS 382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97). CONCLUSIONS This study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.
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Affiliation(s)
- Rana Damsees
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
- Department of Science, Technology and Research, UAE Ministry of Education, Abu Dhabi, UAE
| | - Madi Jaghbir
- Department of Family and Community Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Salam
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Nedal Al-Rawashdeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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Lohiniva AL, Isosomppi S, Pasanen S, Sutinen J. A qualitative study to identify thematic areas for HIV related patient-reported outcome measures (PROM) and patient-reported experience measures (PREM). J Patient Rep Outcomes 2023; 7:41. [PMID: 37126134 PMCID: PMC10151440 DOI: 10.1186/s41687-023-00582-y] [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: 08/26/2022] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The use of patient-reported outcome measures (PROM) and patient-reported experience measures (PREM) provide health providers with valuable feedback on how to improve clinical care and patient outcomes. This paper describes a qualitative study that was conducted to learn about factors influencing the well-being of people living with HIV (PLHIV) in Finland. The findings will be used to develop themes for HIV-specific PROM and PREM questions. METHODS PROMs and PREMs were developed by the Finnish Institute for Health (THL) as a part of a project to develop a national quality-of-care registry for HIV. The study aimed to identify issues and concerns among people living with HIV (PLHIV) that influence their well-being (PROMs) and their experiences in the healthcare system (PREMs). The data were collected through face-to-face in-depth interviews and focus group discussions based on open-ended and semi-structured questions. The data were analyzed using thematic analysis. RESULTS The assessment identified the following PROMs of concern: psychological well-being, concerns about stigma, physical health, social well-being, sexual well-being, medication uptake, managing other medications with antiretrovirals (ARVs), and growing old. The assessment identified the following PREMs: helping patients understand their own health status, proving an opportunity for patients to discuss physical health, psychological and sexual well-being, supporting the uptake of ARVs, assisting patients with medication use, showing compassion towards patients, and empowering patients against stigma. CONCLUSION These findings of the study can be used to develop domain-specific PROM and PREM questions for the national HIV quality care register.
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Affiliation(s)
| | | | - Sini Pasanen
- HivFinland (patient organization), Helsinki, Finland
| | - Jussi Sutinen
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Gurné FL, Svensson PA, Björkman I, Lidén E, Jakobsson S. Seeking lifestyle counselling at primary health care centres: a cross-sectional study in the Swedish population. BMC PRIMARY CARE 2023; 24:74. [PMID: 36941550 PMCID: PMC10026786 DOI: 10.1186/s12875-023-02035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Millions of people follow an unhealthy lifestyle in terms of tobacco consumption, hazardous use of alcohol, poor eating habits, and insufficient physical activity. Healthy lifestyles can to a large extent prevent and/or delay progression of non-communicable diseases. Factors influencing persons health-seeking behaviour regarding unhealthy lifestyles are of importance for sustainable health-promotive and disease-preventive work in primary health care. Generally, lifestyle interventions within primary health care are seen as feasible, but rarely reach all members of the general population. Few studies have been conducted about the likelihood among the general population to voluntarily contact a primary health care centre for support regarding lifestyle changes. The present study therefore aimed to investigate the general population's likelihood of contacting a primary health care centre regarding their lifestyles, and factors associated with a lower such likelihood. METHODS A probability sample of adults living in Sweden (n = 3 750) were invited to participate in a cross-sectional survey regarding how societal developments affect attitudes and behaviours of the adult Swedish population. Data were collected between September and December 2020. Participants completed a questionnaire about lifestyle changes, and the data were analysed using descriptive statistics, Chi-square test and logistic regression analysis. RESULTS The response rate was 52.0% (n = 1 896). Few persons responded that they would be likely to contact a primary health care centre for support regarding their lifestyles. Factors predicting a lower likelihood of contacting primary health care included few yearly visits to a primary health care centre, male sex, and living in a rural area. CONCLUSIONS Primary health care centres are not the first choice for lifestyle counselling for the majority of adults living in Sweden. We have identified factors predicting low likelihood of using the support available at these centres. In order to work with sustainable and visible health-promotive and disease-preventive strategies at primary health care centres, these settings need to find valid methods to involve and collaborate with the members of the general community, to meet the needs of a population struggling with unhealthy lifestyles.
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Affiliation(s)
- Frida Lundin Gurné
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden.
| | - Per-Arne Svensson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
| | - Ida Björkman
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
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Bouyssi A, Prebois S, Rougé-Bugat ME, Dupouy J, Driot D. [Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]. L'ENCEPHALE 2023; 49:65-71. [PMID: 36253178 DOI: 10.1016/j.encep.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation. METHODS A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests. RESULTS A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001). CONCLUSIONS GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.
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Affiliation(s)
- A Bouyssi
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France
| | - S Prebois
- Centre hospitalier universitaire Toulouse Purpan, service de psychiatrie, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - M-E Rougé-Bugat
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - J Dupouy
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - D Driot
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France.
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15
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Dlamini SB, Sartorius B, Ginindza TG. Pre- and post-intervention survey on lung cancer awareness among adults in selected communities in KwaZulu-Natal, South Africa: A quasi-experimental study. J Public Health Afr 2023; 14:2131. [PMID: 36798842 PMCID: PMC9926557 DOI: 10.4081/jphia.2023.2131] [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: 01/19/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background Lung cancer remains the number one cause of cancer mortality estimated at 1.8 million deaths. There are limited studies in resource poor countries regarding knowledge, attitudes and practices towards lung cancer. Objective This study aimed to assess the effects of a lung cancer awareness intervention in selected communities in KwaZulu- Natal, South Africa. Materials and Methods A quasi-experimental study design was conducted in the selected communities in KwaZulu-Natal. A community intervention was administered in the communities after a baseline survey. The intervention effects were assessed a month after implementation. Results There were statistical differences in the mean age (p<0.001) and proportion of males and females (p<0.001) at baseline and post-intervention. There were no differences in terms of smoking status (p=0.958), however, there was a reduction in the number of cigarettes smoked per day (p<0.001) and the number of packs smoked per week (p=0.026). The mean knowledge score increased from 41.8% (95% CI 35.7 - 47.9) at baseline to 59.9 (95% CI 53.8 - 66.0) post-intervention (p<0.001). The proportion of participants who were aware that lung cancer can be detected early increased from 46.5% (95% CI 39.1 - 53.9) at baseline to 81.1% (95% CI 71.7 - 87.9) post-intervention (p<0.001). The intervention had a statistically significant effect (aOR 4.370, 95% CI 1.477-12.928) on the level of lung cancer knowledge in the selected communities (p<0.001). Conclusions Interventions increasing the recognition of signs and symptoms, focusing on the importance of early detection and health seeking behaviour (including screening), smoking cessation, and addressing the perceived health system barriers are required.
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Affiliation(s)
- Siyabonga B. Dlamini
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, 4041, Durban, South Africa, Tel. (+2731) 260 4499. Fax. (+2731) 260 4211.
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Felsher M, Setiawan D, Varga S, Perry R, Riley D, Newman R, Beveridge A, Oswald C, Kothari S, Sukarom I, Postma M. Economic and humanistic burden of HPV-related disease in Indonesia: A qualitative analysis. Glob Public Health 2023; 18:2237096. [PMID: 37487234 DOI: 10.1080/17441692.2023.2237096] [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: 12/08/2022] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
The burden of human papillomavirus (HPV) and HPV-related cancers and genital warts is increasing in developing countries, including Indonesia. The objective of this study was to qualitatively explore the humanistic and economic burden of these HPV-related diseases in patients in Indonesia. In 2021, in-depth interviews and focus groups were conducted with patients (N = 18) with HPV-related diseases and healthcare professionals (HCPs; N = 10) specialised in treating these patients. Interviews explored the physical, mental, social, and economic burden of HPV-related diseases. Patients emphasised the psychological and social burden of HPV-related diseases, which negatively impacted their mental state and close relationships. Treatment for HPV-related diseases was also associated with a substantial cost, which health insurance only partially alleviated. HCPs understood the physical negative impact of HPV-related diseases, but some understated patients' social, psychological, and financial burden. This research underscores the substantial economic and humanistic burden of HPV-related diseases that could be prevented by vaccination. In addition, it highlights the need for novel interventions to reduce negative psychosocial consequences of HPV-related diseases in Indonesia. Increased HCP education of the broader humanistic impacts of HPV-related diseases may improve patient support and increase awareness for preventive strategy.
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Affiliation(s)
- Marisa Felsher
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
| | - Didik Setiawan
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands
- Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Stefan Varga
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
| | | | | | | | | | | | - Smita Kothari
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
| | - Isaya Sukarom
- Center for Observational and Real-World Evidence (CORE) Asia Pacific, MSD, Bangkok, Thailand
| | - Maarten Postma
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands
- Faculty of Economics & Business, Department of Economics, Econometrics & Finance, University of Groningen, Groningen, Netherlands
- Department of Health Sciences, University of Groningen, University Medical Center, Groningen, Netherlands
- Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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Vognsgaard F, Sætre LMS, Rasmussen S, Jarbøl DE. Associations between smoking status and involvement of personal and professional relations among individuals reporting symptoms related to a diagnosis of lung cancer: a population-based study. BMC Public Health 2022; 22:2284. [PMID: 36474198 PMCID: PMC9724281 DOI: 10.1186/s12889-022-14719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Smoking is the leading cause of lung cancer, but individuals who currently smoke seek healthcare less frequently. This study of individuals reporting symptoms related to diagnosis of lung cancer has the following aims: 1) to explore the involvement of personal and professional relations; 2) to analyse whether age, sex and smoking status are associated with involving personal and professional relations; and 3) to analyse whether involving a personal relation is associated with healthcare-seeking. METHODS Data was extracted from a Danish population-based survey from 2012 with 100,000 randomly selected invitees 20 years or older. We describe the involvement of personal and professional relations among individuals experiencing four predefined symptoms indicative of lung cancer: prolonged coughing, prolonged hoarseness, shortness of breath and haemoptysis, either alone or in combination. Using multivariate logistic regression, we analyse the associations between involving personal or professional relations and various covariates (sex, age, smoking status). Moreover, we analyse the association between involving a personal relation and healthcare-seeking. RESULTS A total of 35,958 individuals over 40 years old completed the questionnaire. Of these, 5,869 individuals reported at least one lung cancer symptom. A higher percentage of participants with prolonged hoarseness and prolonged coughing reported no involvement of personal and professional relations (27.6% and 22.7%, respectively) compared to shortness of breath (12.4%). The most involved personal and professional relations were the spouse (46.2-62.5%) and the general practitioner (GP) (31.3-54.5%), respectively. Women and individuals in the oldest age group had higher odds of involving personal and professional relations. Individuals who currently smoke involved all relations less frequently than individuals who formerly,- and never smoked. Odds of contacting the GP or another doctor were three to seven-fold higher when a personal relation was also involved. CONCLUSION Women and the oldest age group had higher odds of involving relations, whereas individuals who currently smoked tended to be less likely to contact any personal or professional relations. Involving a personal relation was associated with higher odds of healthcare-seeking. The findings could be useful for GPs in terms of identifying patients at risk of postponing relevant healthcare-seeking with potential lung cancer symptoms.
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Affiliation(s)
- Frederik Vognsgaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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18
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Black GB, van Os S, Whitaker KL, Hawkins GS, Quaife SL. What are the similarities and differences in lung cancer symptom appraisal and help-seeking according to smoking status? A qualitative study with lung cancer patients. Psychooncology 2022; 31:2094-2103. [PMID: 36131549 PMCID: PMC10099562 DOI: 10.1002/pon.6041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Lung cancer in never-smokers represents a growing proportion of patients. The relationship between smoking status, symptom appraisal and help-seeking behaviour is complex. Little is known about cancer symptom-related health behaviours according to smoking status. The aim of the study was to explore lung cancer patients' experiences of a lung cancer diagnosis, identifying differences by smoking history. METHOD This was a qualitative study involving telephone interviews with 40 lung cancer patients (20 never smokers, 11 former smokers and 9 current smokers). We used framework analysis to analyse the data using the Common Sense Model of Illness Self-Regulation as a theoretical framework, developed after initial analysis. RESULTS All patients were likely to delay seeking help for symptoms in primary care regardless of smoking history, but for different reasons. Smoking history was instrumental to how individuals perceived and responded to early symptoms of lung cancer. Differences in interpretation and coping responses to new symptoms seemed to be caused by the higher presence of comorbidities due to smoking, and perceptions of the current state of health. Individuals with a smoking history reported acting with urgency in seeking help and follow up, whereas patients who experienced low levels of concern were more easily reassured by clinicians, resulting in delays. CONCLUSIONS Never and former smokers perceive, interpret, and respond to symptoms of lung cancer differently to smokers. However, few people attribute their lung symptoms to cancer initially, even with a smoking history. Interventions that drive increased urgency and vigilance in never smokers may be effective.
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Affiliation(s)
- Georgia B. Black
- Department of Applied Health ResearchUniversity College LondonLondonUK
- Centre for PreventionDetection and DiagnosisWolfson Institute of Population HealthBarts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Sandra van Os
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | | | | | - Samantha L. Quaife
- Centre for PreventionDetection and DiagnosisWolfson Institute of Population HealthBarts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimizing the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect 2022; 25:3246-3258. [PMID: 36263948 PMCID: PMC9700133 DOI: 10.1111/hex.13632] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.
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Affiliation(s)
- Debbie Cavers
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Mia Nelson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jasmin Rostron
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
- Present address:
The National Institute of Economic and Social Research2 Dean Trench Street, London NW1P 3HEUK
| | - Kathryn A. Robb
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Christine Campbell
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ahsan R. Akram
- Centre for Inflammation Research and Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Graeme Dickie
- Care of the Usher InstituteUniversity of Edinburgh, EdinburghEdinburghUK
| | | | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Robert J. Steele
- School of Medicine, Ninewells HospitalUniversity of DundeeDundeeUK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - David Weller
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
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Sætre LMS, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. A population-based study on social inequality and barriers to healthcare-seeking with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:48. [PMID: 36335123 PMCID: PMC9637082 DOI: 10.1038/s41533-022-00314-7] [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: 04/25/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
Healthcare-seeking with lung cancer symptoms is a prerequisite for improving timely diagnosis of lung cancer. In this study we aimed to explore barriers towards contacting the general practitioner (GP) with lung cancer symptoms, and to analyse the impact of social inequality. The study is based on a nationwide survey with 69,060 individuals aged ≥40 years, randomly selected from the Danish population. The survey included information on lung cancer symptoms, GP contacts, barriers to healthcare-seeking and smoking status. Information about socioeconomics was obtained by linkage to Danish Registers. Descriptive statistics and multivariate logistic regression model were used to analyse the data. “Being too busy” and “Being worried about wasting the doctor’s time” were the most frequent barriers to healthcare-seeking with lung cancer symptoms. Individuals out of workforce and individuals who smoked more often reported “Being worried about what the doctor might find” and “Being too embarrassed” about the symptoms. The social inequality in barriers to healthcare-seeking with lung cancer symptoms is noticeable, which emphasises the necessity of focus on vulnerable groups at risk of postponing relevant healthcare-seeking.
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Affiliation(s)
- Lisa Maria Sele Sætre
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Bu L, Chen X, Zheng S, Fan G. Construction of the structural equation model of stigma, self-disclosure, social support, and quality of life of breast cancer patients after surgery——A multicenter study.. [DOI: 10.21203/rs.3.rs-2076682/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose: Stigma is common in patients with breast cancer after surgery, which has a negative impact on the quality of life(QOL). This study aimed to investigate the QOL of breast cancer patients after surgery and to analyze the multiple chains mediating effects of self-disclosure and social support between stigma and QOL.
Methods: A total 292 patients of breast cancer patients after operation were recruited in this study. A questionnaire survey was conducted using the general information questionnaire, the consumer experiences of stigma questionnaire (CESQ), the distress disclosure index(DDI), the perceived social support scale(PSSS), and the functional assessment of cancer therapy-breast(FACT-B). Path analysis was conducted to test the hypothesized serial multiple mediation model.
Results: The total scores of stigma, self-disclosure, social support and QOL were 15 (10 ~ 22), 39 (31 ~ 46), 58 (50 ~ 67) and 88 (74 ~ 104) respectively. QOL of breast cancer patients after the operation was negatively correlated with stigma (p < 0.01), and positively correlated with self-disclosure and social support (p < 0.01). Self-disclosure and social support played a complete mediating effect between stigma and QOL, and the total mediating effect value was 85. 87%.
Conclusions: Self-disclosure and social support play a complete intermediary role between stigma and QOL. In order to improve the quality of life of patients, medical staff should pay attention to the assessment of stigma, encourage patients to express their emotions, and encourage their families and friends to respond to their expression and needs of patients.
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Affiliation(s)
| | - Xisui Chen
- First Affiliated Hospital of Shantou University Medical College
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Collier S, Singh R, Semeere A, Byakwaga H, Laker‐Oketta M, McMahon DE, Chemtai L, Grant M, Butler L, Bogart L, Bassett IV, Kiprono S, Maurer T, Martin J, Busakhala N, Freeman EE. Telling the story of intersectional stigma in HIV-associated Kaposi's sarcoma in western Kenya: a convergent mixed-methods approach. J Int AIDS Soc 2022; 25 Suppl 1:e25918. [PMID: 35818882 PMCID: PMC9274375 DOI: 10.1002/jia2.25918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/28/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The experience of stigma can be multifaceted for people with HIV and cancer. Kaposi's sarcoma (KS), one of the most common HIV-associated cancers in sub-Saharan Africa, often presents with visible skin lesions that may put people at risk for stigmatization. In this way, HIV-associated KS is unique, as people with KS can experience stigma associated with HIV, cancer, and skin disease simultaneously. The aim of this study is to characterize the intersectionality of HIV-related, cancer-related and skin disease-related stigma in people living with HIV and KS. METHODS We used a convergent mixed-methods approach nested within a longitudinal study of people with HIV-associated KS in western Kenya. Between February 2019 and December 2020, we collected quantitative surveys among all participants and conducted semi-structured interviews among a purposive sample of participants. Quantitative surveys were adapted from the abridged Berger HIV Stigma Scale to assess overall stigma, HIV-related stigma, cancer-related stigma, and skin disease-related stigma. Qualitative data were coded using stigma constructs from the Health Stigma and Discrimination Framework. RESULTS In 88 semi-structured interviews, stigma was a major barrier to KS diagnosis and treatment among people with HIV-associated KS. Participant's stories of stigma were dominated by HIV-related stigma, more than cancer-related or skin disease-related stigma. However, quantitative stigma scores among the 117 participants were similar for HIV-related (Median: 28.00; IQR: 28.0, 34.0), cancer-related (Median: 28.0; IQR: 28.0, 34.8), and skin disease-related stigma (Median: 28.0; IQR: 27.0, 34.0). In semi-structured interviews, cancer-related and skin disease-related stigma were more subtle contributors; cancer-related stigma was linked to fatalism and skin-related stigma was linked to visible disease. Participants reported resolution of skin lesions contributed to lessening stigma over time; there was a significant decline in quantitative scores of overall stigma in time since KS diagnosis (adjusted β = -0.15, p <0.001). CONCLUSIONS This study highlights the role mixed-method approaches can play in better understanding stigma in people living with both HIV and cancer. While HIV-related stigma may dominate perceptions of stigma among people with KS in Kenya, intersectional experiences of stigma may be subtle, and quantitative evaluation alone may be insufficient to understand intersectional stigma in certain contexts.
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Affiliation(s)
- Sigrid Collier
- Division of DermatologyUniversity of WashingtonSeattleWashingtonUSA
| | - Rhea Singh
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Aggrey Semeere
- Infectious Disease InstituteMakerere UniversityKampalaUganda
| | - Helen Byakwaga
- Infectious Disease InstituteMakerere UniversityKampalaUganda
| | | | - Devon E. McMahon
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Linda Chemtai
- Academic Model Providing Access to HealthcareEldoretKenya
| | - Merridy Grant
- Centre for Rural HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Lisa Butler
- Institute for Collaboration on HealthIntervention and PolicyUniversity of ConnecticutStorrsConnecticutUSA
| | | | - Ingrid V. Bassett
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Samson Kiprono
- Academic Model Providing Access to HealthcareEldoretKenya
- Department of Internal Medicine, School of MedicineCollege of Health SciencesMoi UniversityEldoretKenya
| | - Toby Maurer
- Department of DermatologyIndiana UniversityIndianapolisIndianaUSA
| | - Jeffrey Martin
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Naftali Busakhala
- Academic Model Providing Access to HealthcareEldoretKenya
- Department of Pharmacology and Toxicology, School of MedicineCollege of Health SciencesMoi UniversityEldoretKenya
| | - Esther E. Freeman
- Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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23
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Snyder S, Kroll JL, Chen AB, Antonoff MB, Yang CC, Milbury K. Moderators of the association between stigma and psychological and cancer-related symptoms in women with non-small cell lung cancer. Psychooncology 2022; 31:1581-1588. [PMID: 35726392 DOI: 10.1002/pon.5982] [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: 01/10/2022] [Revised: 04/12/2022] [Accepted: 06/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Lung cancer patients, particularly women, are vulnerable to experience disease-related stigma, which is linked to greater psychological distress and worse treatment outcomes. To inform future stigma-resilience interventions, we examined if mindfulness, self-compassion, and social support might buffer the associations between perceived lung cancer stigma and psychological and cancer-related symptoms. METHODS In this cross-sectional study, women with recently diagnosed non-small cell lung cancer undergoing cancer treatment completed measures of Cataldo Lung Cancer Stigma Scale, depressive (Center for Epidemiologic Studies Depression Scale), stress (Impact of Events Scale) and cancer-related (MD Anderson Symptom Inventory-Lung Cancer) symptoms, mindfulness (Mindful Attention Awareness Scale), self-compassion (Self-Compassion Scale), and social support (Social Provisions Scale). RESULTS The sample included 56 women (mean age = 65 years; 71% non-Hispanic White; 50% college educated; 74% advanced stage) who had consented to participate in an online support group study. Most (70%) had a smoking history and reported moderate levels of stigma (M = 36.28, SD = 10.51). Based on general linear modeling, mindfulness moderated the associations between stigma and depressive symptoms (F = 5.78, p = 0.02), cancer-related stress (F = 12.21, p = 0.002), and cancer-related symptom severity (F = 4.61, p = 0.04), such that, only for women scoring low in mindfulness, the associations between stigma and symptoms were significant. For those scoring high in mindfulness, the associations between stigma and symptoms were not significant supporting a buffering effect. Self-compassion and social support did not significantly moderate the stigma and symptom associations. CONCLUSIONS Higher levels of mindfulness may protect women from psychological and cancer-related symptoms typically associated with the stigmatizing experience of a lung cancer diagnosis. Yet, longitudinal studies and randomized controlled designs are needed to identify mindfulness as a causal protective factor.
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Affiliation(s)
- Stella Snyder
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juliet L Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aileen B Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mara B Antonoff
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claire Chunyi Yang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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24
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van Os S, Syversen A, Whitaker KL, Quaife SL, Janes SM, Jallow M, Black G. Lung cancer symptom appraisal, help-seeking and diagnosis - rapid systematic review of differences between patients with and without a smoking history. Psychooncology 2022; 31:562-576. [PMID: 34766413 DOI: 10.1002/pon.5846] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in the world. A significant minority of lung cancer patients have never smoked (14% in the UK, and ranging from 10% to 25% worldwide). Current evidence suggests that never-smokers encounter delays during the diagnostic pathway, yet it is unclear how their experiences and reasons for delayed diagnoses differ from those of current and former smokers. This rapid review assessed literature about patient experiences in relation to symptom awareness and appraisal, help-seeking, and the lung cancer diagnostic pathway, comparing patients with and without a smoking history. METHODS MEDLINE, PsychINFO and Google Scholar were searched for studies (2010-2020) that investigated experiences of the pathway to diagnosis for patients with and without a smoking history. Findings are presented using a narrative synthesis. RESULTS Analysis of seven quantitative and three qualitative studies revealed that some delays during symptom appraisal and diagnosis are unique to never-smokers. Due to the strong link between smoking and lung cancer, and low awareness of non-smoking related lung cancer risk factors and symptoms, never-smokers do not perceive themselves to be at risk. Never-smokers are also likely to evaluate their experiences in comparison with other non-smoking related cancers, where prognosis is likely better, potentially leading to lower satisfaction with healthcare. CONCLUSION Never-smokers appear to have different experiences in relation to symptom appraisal and diagnosis. However, evidence in relation to help-seeking, and what is driving diagnostic delays for never-smoker patients specifically is lacking.
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Affiliation(s)
- Sandra van Os
- Department of Applied Health Research, University College London, London, UK
| | - Aron Syversen
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Mbasan Jallow
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Georgia Black
- Department of Applied Health Research, University College London, London, UK
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25
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Ginjupalli R, Mundaden R, Choi Y, Herfel E, Oketch SY, Watt MH, Makhulo B, Bukusi EA, Huchko M. Developing a framework to describe stigma related to cervical cancer and HPV in western Kenya. BMC Womens Health 2022; 22:39. [PMID: 35148778 PMCID: PMC8832662 DOI: 10.1186/s12905-022-01619-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite a high prevalence of human papillomavirus (HPV) and cervical cancer in low and middle-income countries, stigma remains an issue. Addressing HPV and cervical cancer stigma could significantly improve health outcomes for these conditions. The objective of this study was to identify the manifestations of stigma and their potential impacts on health-seeking behavior. METHODS Twenty-six in-depth interviews were conducted with women living with HIV, HIV-negative women, community health volunteers, and health care providers in Kisumu, Kenya in 2019. The interviews were designed to draw out existing attitudes or experiences related to stigma within the community. We conducted a thematic analysis of the interviews to identify internalized, anticipated, and discriminatory attitudes. RESULTS Within internalized attitudes, a prominent observed theme was a fear of death associated with a positive HPV test. This stemmed from a lack of understanding of differences between HPV and cervical cancer and posed a significant barrier for women deciding to seek screening or to continue with treatment. Discriminatory attitudes of community members, including assumptions of promiscuity, infidelity, or HIV status, were perceived to prevent women from accessing screening and treatment opportunities. The interviews also exhibited a limited awareness of HPV in this region, which may have contributed to a lack of enacted stigma towards people living with HPV or cervical cancer. CONCLUSION Stigma has the potential to lead to decreased screening and treatment uptake through its drivers. This includes a decreased perception of personal risk due to a lack of knowledge, which results in increased HPV-risk behaviors. Future research must focus on creating and integrating stigma-reducing interventions, primarily to encourage women to seek out primary and secondary preventative measures.
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Affiliation(s)
- Ramya Ginjupalli
- Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA.
| | - Rachel Mundaden
- Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA
| | - Yujung Choi
- Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA
| | - Emily Herfel
- Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA
- Department of Obstetrics and Gynecology, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Sandra Yvonne Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, P.O. Box 54840 00200, Nairobi, Kenya
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Williams Building, Room 1N490, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Breandan Makhulo
- Center for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, P.O. Box 54840 00200, Nairobi, Kenya
| | - Elizabeth Anne Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Off Mbagathi Road, P.O. Box 54840 00200, Nairobi, Kenya
| | - Megan Huchko
- Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA
- Department of Obstetrics and Gynecology, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA
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26
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Bulls HW, Chu E, Goodin BR, Liebschutz JM, Wozniak A, Schenker Y, Merlin JS. Framework for opioid stigma in cancer pain. Pain 2022; 163:e182-e189. [PMID: 34010940 PMCID: PMC8589872 DOI: 10.1097/j.pain.0000000000002343] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
ABSTRACT Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework-the opioid stigma framework (OSF)-with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.
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Affiliation(s)
- Hailey W. Bulls
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edward Chu
- Department of Medicine & Molecular Pharmacology, Albert
Einsten Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research
on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Antoinette Wozniak
- Division of Hematology/Oncology, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Patients' Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships. Cancer Nurs 2022; 45:397-405. [PMID: 35067577 PMCID: PMC9294071 DOI: 10.1097/ncc.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients' perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures. OBJECTIVE The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non-small cell lung cancer. METHODS A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer. RESULTS Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship. CONCLUSIONS Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients' specific needs. IMPLICATIONS FOR PRACTICE Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
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28
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Brown R, Coventry L, Sillence E, Blythe J, Stumpf S, Bird J, Durrant AC. Collecting and sharing self-generated health and lifestyle data: Understanding barriers for people living with long-term health conditions - a survey study. Digit Health 2022; 8:20552076221084458. [PMID: 35284085 PMCID: PMC8905063 DOI: 10.1177/20552076221084458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background The growing popularity of collecting self-generated health and lifestyle data presents a valuable opportunity to develop our understanding of long-term health conditions and improve care. Barriers remain to the effective sharing of health and lifestyle data by those living with long-term health conditions which include beliefs around concepts of Trust, Identity, Privacy and Security, experiences of stigma, perceptions of risk and information sensitivity. Method We surveyed 250 UK adults who reported living with a range of long-term health conditions. We recorded data to assess self-reported behaviours, experiences, attitudes and motivations relevant to sharing self-generated health and lifestyle data. We also asked participants about their beliefs about Trust, Identity, Privacy and Security, stigma, and perceptions of risk and information sensitivity regarding their health and lifestyle data. Results Three-quarters of our sample reported recording information about their health and lifestyle on a daily basis. However, two-thirds reported never or rarely sharing this information with others. Trust, Identity, Privacy and Security concerns were considered to be 'very important' by those with long-term health conditions when deciding whether or not to share self-generated health and lifestyle data with others, with security concerns considered most important. Of those living with a long-term health condition, 58% reported experiencing stigma associated with their condition. The greatest perceived risk from sharing with others was the potential for future harm to their social relationships. Conclusions Our findings suggest that, in order for health professionals and researchers to benefit from the increased prevalence of self-generated health and lifestyle data, more can be done to address security concerns and to understand perceived risks associated with data sharing. Digital platforms aimed at facilitating the sharing of self-generated health and lifestyle data may look to highlight security features, enable users to control the sharing of certain information types, and emphasise the practical benefits to users of sharing health and lifestyle data with others.
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Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | - Lynne Coventry
- Psychology Department, Northumbria University, Newcastle, UK
| | | | | | - Simone Stumpf
- Department of Computer Science, City University of London, UK
| | - Jon Bird
- Department of Computer Science, University of Bristol, UK
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29
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Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa. AIDS Behav 2021; 25:3967-3977. [PMID: 33999300 PMCID: PMC8127851 DOI: 10.1007/s10461-021-03307-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/04/2023]
Abstract
We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy.
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30
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Lv XQ, Feng Y, Li JR, Zhang XQ, Xiang R, Hong JF. Validation of a Chinese version of the short-form Cataldo lung cancer stigma scale. Heart Lung 2021; 51:59-66. [PMID: 34731699 DOI: 10.1016/j.hrtlng.2021.08.004] [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: 03/26/2021] [Revised: 08/08/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung cancer stigma is a widespread psychosocial problem. We developed a short form of the Cataldo lung cancer stigma scale for Chinese people with lung cancer (CLCSS-C-SF) and compared its psychometric properties with those of the full and short versions. METHODS This was a secondary analysis using data from the full CLCSS-C, distress thermometer and perceived social support of Chinese people with lung cancer (N = 394). Exploratory and confirmatory factor analysis (CFA) were used to identify factor structure and assess construct validity. The internal consistency and concurrent and known-group validity were evaluated. RESULTS The 22-item CLCSS-C-SF comprised four factors. The convergent validity evaluated using average variance extracted and discriminant validity were acceptable. Cronbach's alphas, concurrent and known-group validity were satisfactory for three versions. Only the four-factor model proposed was validated by CFA. CONCLUSION The CLCSS-C-SF is reliable and valid and can be used in Chinese lung cancer populations.
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Affiliation(s)
- Xiao-Qing Lv
- School of Nursing, Anhui Medical University, Anhui, PR China.
| | - Yuan Feng
- School of Nursing, Anhui Medical University, Anhui, PR China.
| | - Jing-Ru Li
- School of Nursing, Anhui Medical University, Anhui, PR China.
| | - Xin-Qiong Zhang
- School of Nursing, Anhui Medical University, Anhui, PR China.
| | - Ru Xiang
- School of Nursing, Anhui Medical University, Anhui, PR China.
| | - Jing-Fang Hong
- School of Nursing, Anhui Medical University, Anhui, PR China.
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31
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Pradipta IS, Idrus LR, Probandari A, Lestari BW, Diantini A, Alffenaar JWC, Hak E. Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient's perspective. BMC Public Health 2021; 21:1903. [PMID: 34670527 PMCID: PMC8529853 DOI: 10.1186/s12889-021-12005-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 10/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background Previously treated tuberculosis (TB) patients are a widely reported risk factor for multidrug-resistant tuberculosis. Identifying patients’ problems during treatment is necessary to control TB, especially in a high-burden setting. We therefore explored barriers to successful TB treatment from the patients’ perspective, aiming to identify potential patient-centred care strategies to improve TB treatment outcome in Indonesia. Methods A qualitative study was conducted in a province of Indonesia with high TB prevalence. Participants from various backgrounds (i.e., TB patients, physicians, nurses, pharmacists, TB activist, TB programmers at the district and primary care levels) were subject to in-depth interviews and focus group discussions (FGDs). All interviews and FGDs were transcribed verbatim from audio and visual recordings and the respective transcriptions were used for data analysis. Barriers were constructed by interpreting the codes’ pattern and co-occurrence. The information’s trustworthiness and credibility were established using information saturation, participant validation and triangulation approaches. Data were inductively analysed using the Atlas.ti 8.4 software and reported following the COREQ 32-items. Results We interviewed 63 of the 66 pre-defined participants and identified 15 barriers. The barriers were classified into three themes, i.e., socio-demography and economy; knowledge and perception and TB treatment. Since the barriers can be interrelated, we determined five main barriers across all barrier themes, i.e., lack of TB knowledge, stigmatisation, long distance to the health facility, adverse drug reaction and loss of household income. Conclusion The main treatment barriers can be considered to strengthen patient-centred care for TB patients in Indonesia. A multi-component approach including TB patients, healthcare providers, broad community and policy makers is required to improve TB treatment success. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12005-y.
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Affiliation(s)
- Ivan S Pradipta
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands. .,Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia. .,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
| | - Lusiana R Idrus
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.,Bekasi General Hospital, West Java Local Government, Bekasi, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Disease Control Research Group, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Bony W Lestari
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Werstmead Hospital, Sydney, Australia
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands
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32
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Kwaghe AV, Kwaghe VG, Habib ZG, Kwaghe GV, Ilesanmi OS, Ekele BA, Umeokonkwo CD, Balogun MS. Stigmatization and psychological impact of COVID-19 pandemic on frontline healthcare Workers in Nigeria: a qualitative study. BMC Psychiatry 2021; 21:518. [PMID: 34670530 PMCID: PMC8528377 DOI: 10.1186/s12888-021-03540-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/14/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a great toll on global health. Frontline healthcare workers (FHCW) directly involved in the treatment of COVID-19 patients have faced some physical and psychological challenges. This study explored the stigma and traumatic experiences of the FHCW during the COVID-19 pandemic in Nigeria. METHODS We recruited twenty FHCW directly involved in the treatment of COVID-19 patients through purposive and snowball sampling techniques. Face-to-face in-depth interviews were conducted for all participants, and qualitative analysis of data was done using Colaizzi's phenomenological method. RESULTS Five themes identified were: Early stage of the pandemic (fear, anxiety, public fright, other countries repatriating their citizens, the socio-economic impact of the pandemic and a call to duty for the FHCW); working with COVID-19 patients (excitement on patients recovery and duty stress); psychological, mental and emotional trauma; stigmatization (stigmatized by colleagues, family, friends or their residential communities, reasons for stigmatization which were fear of infection, limited knowledge of the virus and working at the isolation centre and the effect of stigma); and recommendations (education and awareness creation, government showing more care towards the FHCW and provision of health insurance for FHCW to take care of those that get infected in the line of duty). CONCLUSION Stigmatization has proven to be a major challenge for FHCW in conducting their duties. The psychological impact experienced by FHCW may affect the quality of the services rendered by these workers. The study reveals the need of education and awareness creation in the ongoing pandemic. There is a need for the government and society to acknowledge and appreciate the efforts of FHCW.
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Affiliation(s)
- Ayi Vandi Kwaghe
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
- Department of Veterinary and Pest Control Services, Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria.
| | - Vivian Gga Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Zaiyad Garba Habib
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gga Vandi Kwaghe
- Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Olayinka Stephen Ilesanmi
- Department of Community Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo State, Nigeria
| | - Bissalah Ahmed Ekele
- Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Chukwuma David Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
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Chew CC, Lim XJ, Chang CT, Rajan P, Nasir N, Low WY. Experiences of social stigma among patients tested positive for COVID-19 and their family members: a qualitative study. BMC Public Health 2021; 21:1623. [PMID: 34488693 PMCID: PMC8419662 DOI: 10.1186/s12889-021-11679-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Social stigma against persons infected with COVID-19 is not uncommon. This qualitative study aimed to explore the experience of social stigma among COVID-19 positive patients and their family members. Method This cross-sectional study was conducted between April to June 2020 in Malaysia. Patients who have recovered from COVID-19 for at least 1 month and their family members who were tested with negative results, Malaysian and aged 18–65 years old were purposively sampled. Cold call method was employed to recruit patients while their family members were recruited by their recommendations. Telephone interviews were conducted with the participants after obtaining their verbal consent. Results A total of 18 participants took part in this study. Three themes emerged from the interviews: (Ι) experience of stigmatization, (ΙΙ) perspective on disease disclosure, and (ΙΙΙ) suggestion on coping and reducing stigma. The participants expressed their experiences of being isolated, labelled, and blamed by the people surrounding them including the health care providers, neighbours, and staff at the service counters. Some respondents expressed their willingness to share their experience with others by emphasizing the importance of taking preventive measure in order to stop the chain of virus transmission and some of them chose to disclose this medical history for official purpose because of fear and lack of understanding among the public. As suggested by the respondents, the approaches in addressing social stigma require the involvement of the government, the public, health care provider, and religious leader. Conclusion Individuals recovered from COVID-19 and their families experienced social stigma. Fear and lack of public understanding of the COVID-19 disease were the key factors for non-disclosure. Some expressed their willingness to share their experience as they perceived it as method to increase public awareness and thereby reducing social stigma. Multifaceted approaches with the involvement of multiple parties including the government, non-governmental organization as well as the general public were recommended as important measures to address the issues of social stigma.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.,Otolaryngology Department, Raja Permaisuri Bainun Hospital, Ministry of Health, Ipoh, Malaysia
| | - Nordin Nasir
- Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Wah-Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kwaghe AV, Ilesanmi OS, Amede PO, Okediran JO, Utulu R, Balogun MS. Stigmatization, psychological and emotional trauma among frontline health care workers treated for COVID-19 in Lagos State, Nigeria: a qualitative study. BMC Health Serv Res 2021; 21:855. [PMID: 34419034 PMCID: PMC8380097 DOI: 10.1186/s12913-021-06835-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 07/30/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND COVID-19 pandemic has resulted in global health and economic crisis. We investigated the experiences of frontline health care workers recovering from COVID-19 in Lagos State Nigeria. METHODS We conducted a qualitative study among frontline health workers recovering from COVID-19 in Lagos State, Nigeria. We interviewed 12 respondents before achieving data saturation. We used a checklist to guide the interview according to the phenomenon under study. Data obtained were analyzed using Colaizzi's phenomenological method. RESULTS The study was summarized under five themes: knowledge of COVID-19, exposure, reactions, challenges and recommendations. The respondents were quite knowledgeable on COVID-19, their reactions when informed of their status were denial, anxiety, distress, disorientation, crying for fear of stigmatization, while some were psychologically prepared. Reactions from colleagues, family and friends were encouraging and provided solace for them with a few colleagues and families that had negative reactions. Challenges include anosmia, movement restriction, loneliness, worries about the state of their families, nondisclosure of status to family members, non-conducive isolation centre with limited space, insomnia, stigmatization by health workers at the isolation centre, extended duration of stay, delay in the release of test results and use of ambulance for evacuation to the isolation centres. Coping strategies were watching movies, phone calls, use of social media, listening to music, attending webinars, working on projects and reading spiritual books. Recommendations were early laboratory testing of samples and conveying of results, increase testing capacity, the need of health care workers to be more compassionate, better method of evacuation of people that tested positive to COVID-19, aside the use of ambulance that increases the likelihood of stigmatization and standard guideline for the case management of people recovering from COVID-19 in Lagos state. CONCLUSIONS Respondents felt stigmatized and psychologically and morally traumatized. Isolation is a difficult experience and some negative emotions as expressed by previous studies were experienced by the respondents. There is need for increased testing capacity, timely results dissemination, early evacuation and creation of more isolation centres in Lagos State due to the rising number of cases and shortage of bed space.
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Affiliation(s)
- Ayi Vandi Kwaghe
- Department of Veterinary and Pest Control Services, Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria.
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
- National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Abuja, Nigeria.
| | - Olayinka Stephen Ilesanmi
- Department of Community Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - Peter Okpeh Amede
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
- Nigerian Correctional Service, Directorate of Health and Social Welfare, Bauchi, Bauchi State, Nigeria
| | - James Olatunde Okediran
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
- Department of Public Health, Federal Capital Territory Administration, Abuja, Nigeria
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Rowland Utulu
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change. BMC Public Health 2021; 21:1524. [PMID: 34372808 PMCID: PMC8351340 DOI: 10.1186/s12889-021-11548-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal. Methods We conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach. Results Major uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment. Conclusions This formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11548-4.
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Lohiniva AL, Dub T, Hagberg L, Nohynek H. Learning about COVID-19-related stigma, quarantine and isolation experiences in Finland. PLoS One 2021; 16:e0247962. [PMID: 33852581 PMCID: PMC8046198 DOI: 10.1371/journal.pone.0247962] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has intensely changed the everyday lives of people worldwide. This study explores the forms and outcomes of coronavirus and COVID-19-related social stigma and the experiences of people who were home quarantined or isolated in Finland during the spring 2020. The findings of this study can be used to improve support for those quarantined or isolated and to develop strategies to reduce the stigma associated with coronavirus and COVID-19. METHODS The study is based on qualitative one-to-one interviews with households with at least two members and at least one PCR confirmed COVID-19 case. Recruitment took place via website or SMS messages sent to PCR confirmed cases in the capital area of Helsinki. Sampling was based on maximum variation to acquire different types of respondents. The framework of health stigma was used to develop question guides and analyze stigma. Quarantine and isolation experiences were explored through open-ended questions. The analysis was based on thematic analysis. RESULTS The study included 64 participants from 24 households. Perceived stigma among respondents was driven by fear and blame for infection, and it manifested in various ways leading to a reluctance to disclose their coronavirus status to others. Self-stigma developed from conflicting information and advice about coronavirus and COVID-19 led to difficulties interacting with others outside of the house and reluctance to meet people after quarantine and isolation. Quarantine and isolation experiences included uncertainty, health concerns, and boredom. Communication with others in similar situations was perceived vital, whereas discussions with family members about worries and fears related to coronavirus and COVID-19 was not preferred. CONCLUSIONS This study shed light on the lives of those quarantined or isolated at home and provided a set of operational recommendations to minimize coronavirus and COVID-19-associated stigma and to reduce challenges faced by those in quarantine or isolation.
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Affiliation(s)
| | - Timothee Dub
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lotta Hagberg
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- The Finnish Institute for Health and Welfare, Helsinki, Finland
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Illingworth P. How do we engage global communities in the de-stigmatisation of mental illness? ACTA ACUST UNITED AC 2021; 30:184-187. [DOI: 10.12968/bjon.2021.30.3.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The World Health Organization (WHO) has acknowledged that high-income countries often address discrimination against people with mental health problems, but that low/middle income countries often have significant gaps in their approach to this subject—in how they measure the problem, and in strategies, policies and programmes to prevent it. Localised actions have occurred. These include the Hong Kong government's 2017 international conference on overcoming the stigma of mental illness, and the 2018 London Global Ministerial Mental Health Summit. Furthermore, the UK's Medical Research Council has funded Professor Graham Thornicroft (an expert in mental health discrimination and stigma) to undertake a global study. These and other approaches are welcome and bring improvements; however, they often rely on traditional westernised, ‘global north’ views/approaches. Given the rapid global demographic changes/dynamics and the lack of evidence demonstrating progress towards positive mental health globally, it is time to consider alternative and transformative approaches that encompasses diverse cultures and societies and aligns to the United Nations' Sustainable Development Goals (SDGs), specifically UN SDG 3 (Good health and wellbeing). This article describes the need for the change and suggests how positive change can be achieved through transnational inclusive mental health de-stigmatising education.
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Affiliation(s)
- Paul Illingworth
- Head of School, The Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester
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Kalinke L, Thakrar R, Janes SM. The promises and challenges of early non-small cell lung cancer detection: patient perceptions, low-dose CT screening, bronchoscopy and biomarkers. Mol Oncol 2020; 15:2544-2564. [PMID: 33252175 PMCID: PMC8486568 DOI: 10.1002/1878-0261.12864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
Lung cancer survival statistics are sobering with survival ranking among the poorest of all cancers despite the addition of targeted therapies and immunotherapies. However, improvements in tools for early detection hold promise. The Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) trial recently corroborated the findings from the previous National Lung Screening Trial low‐dose Computerised Tomography (NLST) screening trial in reducing lung cancer mortality. Biomarker research and development is increasing at pace as the molecular life histories of lung cancers become further unravelled. Low‐dose CT screening (LDCT) is effective but targets only those at the highest risk and is burdensome on healthcare. An optimally designed CT screening programme at best will only detect a low proportion of overall lung cancers as only those at very high‐risk meet screening criteria. Biomarkers that help risk stratify suitable patients for LDCT screening, and those that assist in determining which LDCT detected nodules are likely to represent malignant disease are needed. Some biomarkers have been proposed as standalone lung cancer diagnosis tools. Bronchoscopy technology is improving, with better capacity to identify and obtain samples from early lung cancers. Clinicians need to be aware of each early lung cancer detection method’s inherent limitations. We anticipate that the future of early lung cancer diagnosis will involve a synergistic, multimodal approach, combining several early detection methods.
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Affiliation(s)
- Lukas Kalinke
- Lungs for Living Research Centre, University College London, UK
| | - Ricky Thakrar
- Lungs for Living Research Centre, University College London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, University College London, UK
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Abstract
Robust evidence exists in support of lung cancer (LC) screening with low-dose computed tomography in patients at high risk of developing LC; however, judicious patient selection is necessary to obtain optimal benefit while minimizing harm. Several professional societies have published recommendations regarding patient selection criteria for screening. Multiple risk prediction models that include additional patient-specific risk factors have since been developed to more accurately predict risk of developing LC. Implementation of a new screening program requires thorough multidisciplinary planning and maintenance. Multisociety guidelines highlight 9 principal components to implement and maintain a successful program.
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Affiliation(s)
- Nina A Thomas
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB Suite 816, MSC 630, Charleston, SC 29425, USA
| | - Nichole T Tanner
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB Suite 816, MSC 630, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, 109 Bee Street, Charleston, SC 29401, USA.
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Dalky HF, Hamdan-Mansour AM, Amarneh BH, AlAzzam RN M, Yacoub NR, Khalifeh AH, Aldalaykeh M, Dalky AF, Rawashdeh RA, Yehia DB, Alnajar M. Social discrimination perception of health-care workers and ordinary people toward individuals with COVID-19. SOCIAL INFLUENCE 2020. [DOI: 10.1080/15534510.2020.1838945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Heyam F. Dalky
- Psychiatric Mental Health, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | | | - Basil H. Amarneh
- Psychiatric Mental Health, Epidemiology, and Biostatistics, Jordan University of Science & Technology, Irbid, Jordan
| | - Manar AlAzzam RN
- Associate professor/Psychiatric Mental Health Nursing, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Anas H. Khalifeh
- Department of Nursing, Prince Hamzah Hospital, Ministry of Health, Amman, Jordan
| | - Mohammed Aldalaykeh
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Alaa Fawwaz Dalky
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | | | | | - Malek Alnajar
- Clinical Instructor, Faculty of Health Science/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates
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Recto P, McGlothen-Bell K, McGrath J, Brownell E, Cleveland LM. The Role of Stigma in the Nursing Care of Families Impacted by Neonatal Abstinence Syndrome. Adv Neonatal Care 2020; 20:354-363. [PMID: 32868585 PMCID: PMC7467149 DOI: 10.1097/anc.0000000000000778] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current US opioid crisis has resulted in a significant increase in opioid use disorder among pregnant and parenting women. Substance use disorders, in general, are highly stigmatized conditions. Stigma serves as a well-documented global barrier to health-seeking behaviors and engagement in healthcare. While extensive research exists on the stigma of mental illness, few studies have explored the stigma experienced by families impacted by neonatal abstinence syndrome (NAS). PURPOSE Therefore, the purpose of this article is to explore the role of stigma in the care of families impacted by NAS. METHODS In this article, we present a discussion about the effects of stigma on this patient population and provide exemplars of stigma experiences from our previous research and the existing literature. FINDINGS/RESULTS Mothers of infants with NAS faced the challenges of overcoming stigma as they were often ostracized, excluded, and shamed. Nurses who provide care for these women and their infants have reported experiencing ethical distress, moral distress, and compassion fatigue. IMPLICATIONS FOR PRACTICE Greater awareness of the impact of opioid use on the maternal-child population has resulted in numerous educational offerings for healthcare providers; however, this alone is not adequate to end stigma. Fortunately, promising tools and methods have been developed for assisting nurses with addressing stigma in a manner that can be both nonconfrontational and highly effective. IMPLICATIONS FOR RESEARCH Future research is needed to explore and evaluate the efficacy of various existing strategies for counteracting harmful stigma in this patient population.
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Affiliation(s)
- Pamela Recto
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Kelly McGlothen-Bell
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Jacqueline McGrath
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Elizabeth Brownell
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Lisa M. Cleveland
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
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Stangl AL, Earnshaw VA, Logie CH, van Brakel W, C. Simbayi L, Barré I, Dovidio JF. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 2019; 17:31. [PMID: 30764826 PMCID: PMC6376797 DOI: 10.1186/s12916-019-1271-3] [Citation(s) in RCA: 619] [Impact Index Per Article: 123.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
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Affiliation(s)
- Anne L. Stangl
- International Center for Research on Women, 1120 20th St. NW, Suite 500N, Washington, DC, 20036 USA
| | - Valerie A. Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE USA
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario Canada
| | | | - Leickness C. Simbayi
- Human Sciences Research Council & Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Iman Barré
- International Center for Research on Women, 1120 20th St. NW, Suite 500N, Washington, DC, 20036 USA
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Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Mazza D, Habgood E, Kutzer Y, Barnes DJ, Murchie P. The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax 2019; 74:362-370. [PMID: 30630891 PMCID: PMC6484693 DOI: 10.1136/thoraxjnl-2018-212506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
Background International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk. Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.
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Affiliation(s)
- Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sonya R Murray
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia
| | - Fiona M Walter
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Emily Habgood
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Kutzer
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - David John Barnes
- Royal Prince Alfred Hospital, Newtown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Murchie
- The Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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44
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Cassim S, Chepulis L, Keenan R, Kidd J, Firth M, Lawrenson R. Patient and carer perceived barriers to early presentation and diagnosis of lung cancer: a systematic review. BMC Cancer 2019; 19:25. [PMID: 30621616 PMCID: PMC6323678 DOI: 10.1186/s12885-018-5169-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023] Open
Abstract
Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved.
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Affiliation(s)
- Shemana Cassim
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand.
| | - Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand
| | - Rawiri Keenan
- School of Nursing, University of Auckland, Auckland, 1023, New Zealand
| | - Jacquie Kidd
- School of Nursing, University of Auckland, Auckland, 1023, New Zealand
| | - Melissa Firth
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, 3240, New Zealand.,Waikato Medical Research Centre, Waikato DHB Campus, Waikato Hospital, Hamilton, 3240, New Zealand
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45
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Hajdarevic S, Rasmussen BH, Overgaard Hasle TL, Ziebland S. Qualitative cross-country comparison of whether, when and how people diagnosed with lung cancer talk about cigarette smoking in narrative interviews. BMJ Open 2018; 8:e023934. [PMID: 30420351 PMCID: PMC6252649 DOI: 10.1136/bmjopen-2018-023934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/20/2018] [Accepted: 09/26/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To compare and examine whether, when and how patients with lung cancer in three countries, with different survival rates, talk about cigarette smoking and its relationship with help-seeking. DESIGN A qualitative cross-country comparison with analysis of narrative interviews. SETTING Participants in Sweden, Denmark and England were interviewed during 2015-2016. Interviews, using a narrative approach, were conducted in participants' home by trained and experienced qualitative researchers. PARTICIPANTS Seventy-two men and women diagnosed with lung cancer were interviewed within 6 months of their diagnosis. RESULTS The English participants, regardless of their own smoking status, typically raised the topic of smoking early in their interviews. Smoking was mentioned in relation to symptom appraisal and interactions with others, including health professionals. Participants in all three countries interpreted their symptoms in relation to their smoking status, but in Sweden (unlike England) there was no suggestion that this deterred them from seeking care. English participants, but not Swedish or Danish, recounted reluctance to consult healthcare professionals with their symptoms while they were still smoking, some gave up shortly before consulting. Some English patients described defensive strategies to challenge stigma or pre-empt other people's assumptions about their culpability for the disease. A quarter of the Danish and 40% of the Swedish participants did not raise the topic of smoking at any point in their interview. CONCLUSION The causal relationship between smoking and lung cancer is well known in all three countries, yet this comparative analysis suggests that the links between a sense of responsibility, stigma and reluctance to consult are not inevitable. These findings help illuminate why English patients with lung cancer tend to be diagnosed at a later stage than their Swedish counterparts.
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Affiliation(s)
| | - Birgit H Rasmussen
- The Institute for Palliative Care, Lund University and Region Skåne, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Surgery, Lund, Sweden
| | - Trine L Overgaard Hasle
- Research Unit of General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
| | - Sue Ziebland
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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46
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Ha D, Ries AL, Montgrain P, Vaida F, Sheinkman S, Fuster MM. Time to treatment and survival in veterans with lung cancer eligible for curative intent therapy. Respir Med 2018; 141:172-179. [PMID: 30053964 PMCID: PMC6104385 DOI: 10.1016/j.rmed.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Institute of Medicine emphasizes care timeliness as an important quality metric. We assessed treatment timeliness in stage I-IIIA lung cancer patients deemed eligible for curative intent therapy and analyzed the relationship between time to treatment (TTT) and timely treatment (TT) with survival. METHODS We retrospectively reviewed consecutive cases of stage I-IIIA lung cancer deemed eligible for curative intent therapy at the VA San Diego Healthcare System between 10/2010-4/2017. We defined TTT as days from chest tumor board to treatment initiation and TT using guideline recommendations. We used multivariable (MVA) Cox proportional hazards regressions for survival analyses. RESULTS In 177 veterans, the median TTT was 35 days (29 days for chemoradiation, 36 for surgical resection, 42 for definitive radiation). TT occurred in 33% or 77% of patients when the most or least timely guideline recommendation was used, respectively. Patient characteristics associated with longer TTT included other cancer history, high simplified comorbidity score, stage I disease, and definitive radiation treatment. In MVA, TTT and TT [HR 0.53 (95% CI 0.27, 1.01) for least timely definition] were not associated with OS in stage I-IIIA patients, or disease-free survival in subgroup analyses of 122 stage I patients [HR 1.49 (0.62, 3.59) for least timely definition]. CONCLUSION Treatment was timely in 33-77% of veterans with lung cancer deemed eligible for curative intent therapy. TTT and TT were not associated with survival. The time interval between diagnosis and treatment may offer an opportunity to deliver or improve other cancer care.
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Affiliation(s)
- Duc Ha
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States.
| | - Andrew L Ries
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Philippe Montgrain
- Section of Pulmonary and Critical Care Medicine, VA San Diego Healthcare System, San Diego, CA, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Florin Vaida
- Division of Biostatistics and Bioinformatics, Department of Family and Preventative Medicine, University of California San Diego, La Jolla, CA, United States
| | - Svetlana Sheinkman
- Section of Pulmonary and Critical Care Medicine, VA San Diego Healthcare System, San Diego, CA, United States
| | - Mark M Fuster
- Section of Pulmonary and Critical Care Medicine, VA San Diego Healthcare System, San Diego, CA, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States
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47
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Hamann HA, Ver Hoeve ES, Carter-Harris L, Studts JL, Ostroff JS. Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum. J Thorac Oncol 2018; 13:1062-1075. [PMID: 29800746 PMCID: PMC6417494 DOI: 10.1016/j.jtho.2018.05.014] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Fully realizing the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of the stigma of lung cancer is based on a multilevel perspective that incorporates the individual, persons in the individual's immediate environment, the health care system, and the larger societal structure that shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally affects psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multilevel role of stigma is a crucial area for future study to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life.
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Affiliation(s)
- Heidi A. Hamann
- University of Arizona, Departments of Psychology and Family and Community Medicine, 1503 E University Blvd., Tucson, AZ, USA, ,
| | - Elizabeth S. Ver Hoeve
- University of Arizona, Departments of Psychology and Family and Community Medicine, 1503 E University Blvd., Tucson, AZ, USA, ,
| | - Lisa Carter-Harris
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, USA,
| | - Jamie L. Studts
- University of Kentucky College of Medicine, Department of Behavioral Science, Lexington, KY, USA,
| | - Jamie S. Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA,
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48
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Barriers to lung cancer care: health professionals' perspectives. Support Care Cancer 2016; 25:497-504. [PMID: 27726030 PMCID: PMC5196009 DOI: 10.1007/s00520-016-3428-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/26/2016] [Indexed: 11/01/2022]
Abstract
PURPOSE Globally, lung cancer is the most common cancer and the leading cause of cancer death. Problematically, there is a wide variation in the management and survival for people with lung cancer and there is limited understanding of the reasons for these variations. To date, the views of health professionals across relevant disciplines who deliver such care are largely absent. The present study describes Australian health professionals' views about barriers to lung cancer care to help build a research and action agenda for improving lung cancer outcomes. METHODS Qualitative semi-structured interviews were undertaken with a multidisciplinary group of 31 Australian health professionals working in lung cancer care for an average of 16 years (range 1-35 yrs.; SD = 10.2) seeing a mean of 116 patients annually. RESULTS Three superordinate themes were identified: illness representations, cultural influences, and health system context. Illness representations included three themes: symptoms attributed as smoking-related but not cancer, health-related stigma, and therapeutic nihilism. Cultural influence themes included Indigenous health care preferences, language and communication, and sociodemographic factors. Health system context included lack of regional services and distance to treatment, poor care coordination, lack of effective screening methods, and health professional behaviours. CONCLUSIONS Fractured and locally isolated approaches routinely confound responses to the social, cultural and health system complexities that surround a diagnosis of lung cancer and subsequent treatment. Improving outcomes for this disadvantaged patient group will require government, health agencies, and the community to take an aggressive, integrated approach balancing health policy, treatment priorities, and societal values.
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49
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Al-Ayoubi AM, Flores RM. Lung cancer screening: did we really need a randomized controlled trial? Eur J Cardiothorac Surg 2016; 50:29-33. [DOI: 10.1093/ejcts/ezw043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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50
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Crane M, Scott N, O'Hara BJ, Aranda S, Lafontaine M, Stacey I, Varlow M, Currow D. Knowledge of the signs and symptoms and risk factors of lung cancer in Australia: mixed methods study. BMC Public Health 2016; 16:508. [PMID: 27296668 PMCID: PMC4906715 DOI: 10.1186/s12889-016-3051-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/29/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in Australia. There is potential that health promotion about the risks and warning signs of lung cancer could be used to reduce delays in symptom presentation when symptoms are first detected. This study investigated knowledge, attitudes and beliefs which might impact help-seeking behaviour and could provide insight into possible public health interventions in New South Wales (NSW). METHODS A convergent mixed method study design was used wherein data from 16 qualitative focus groups of residents (40+ years), purposefully recruited and stratified by smoking status, age and geography (metropolitan/regional), were compared with a CATI administered population-wide telephone survey (n = 1,000) using the Cancer Research UK cancer awareness measure (LungCAM). Qualitative findings were analysed thematically using NVIVO. Logistic regression analysis was used to investigate predictors of symptom knowledge in STATA. Findings were integrated using triangulation techniques. RESULTS Across focus groups, haemoptysis was the only symptom creating a sense of medical urgency. Life experiences evoked a 'wait and see' attitude to any health deterioration. Perceived risk was low amongst those at risk with current smokers preferring to deny their risk while former smokers were generally unaware of any ongoing risk. The quantitative sample consisted of females (62 %), 40-65 years (53 %), low SES (53 %), former (46 %) and current smokers (14 %). In quantitative findings, haemoptysis and dyspnoea were the most recognised symptoms across the sample population. Age (<65 years), sex (female) and high socio-economic status contributed to a higher recognition of symptoms. Smoking was recognised as a cause of lung cancer, yet ever-smokers were less likely to recognise the risk of lung cancer due to second-hand smoke (OR 0.7 95 % CI 0.5-0.9). CONCLUSION While there was some recognition of risk factors and symptoms indicative of lung cancer, there was disparity across the sample population. The qualitative findings also suggest that knowledge may not lead to earlier presentation; a lack of urgency about symptoms considered trivial, and smoking-related barriers such as stigma may also contribute to time delays in presentation. Public health interventions may be required to increase awareness of risk and emphasise the importance of seeking medical attention for ongoing symptoms.
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Affiliation(s)
- Melanie Crane
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Nicola Scott
- Cancer Institute NSW, L9, 8 Central Ave, Australian Technology Park, Eveleigh, NSW, 2015, Australia
| | - Blythe J O'Hara
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sanchia Aranda
- Cancer Council Australia, L24, 477 Pitt Street, Sydney, NSW, 2000, Australia
| | - Mayanne Lafontaine
- Faculty of Arts and Social Sciences, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Ingrid Stacey
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Megan Varlow
- Cancer Institute NSW, L9, 8 Central Ave, Australian Technology Park, Eveleigh, NSW, 2015, Australia
| | - David Currow
- Cancer Institute NSW, L9, 8 Central Ave, Australian Technology Park, Eveleigh, NSW, 2015, Australia
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